Provider Demographics
NPI:1548328867
Name:TERRY D. HUSEMAN OD PC
Entity type:Organization
Organization Name:TERRY D. HUSEMAN OD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:INSURANCE PROCESSOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRIGITTE
Authorized Official - Middle Name:
Authorized Official - Last Name:POWERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:515-224-9681
Mailing Address - Street 1:1551 VALLEY WEST DR
Mailing Address - Street 2:SUITE 242
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-1112
Mailing Address - Country:US
Mailing Address - Phone:515-224-9681
Mailing Address - Fax:515-224-9687
Practice Address - Street 1:1551 VALLEY WEST DR
Practice Address - Street 2:SUITE 242
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1112
Practice Address - Country:US
Practice Address - Phone:515-224-9681
Practice Address - Fax:515-224-9687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA02224152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1407838436OtherINDIVIDUAL NPI NUMBER
IA1932189354OtherINDIVIDUAL NPI NUMBER
IA1043280977OtherINDIVIDUAL NPI NUMBER
I20611Medicare PIN
IA1932189354OtherINDIVIDUAL NPI NUMBER
IA1043280977OtherINDIVIDUAL NPI NUMBER
1407838436OtherINDIVIDUAL NPI NUMBER
IAV04084Medicare UPIN
I14744Medicare PIN