Provider Demographics
NPI:1548458755
Name:SHEETS, TERRY F (LDO)
Entity type:Individual
Prefix:MR
First Name:TERRY
Middle Name:F
Last Name:SHEETS
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9030 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-7741
Mailing Address - Country:US
Mailing Address - Phone:513-791-3336
Mailing Address - Fax:513-791-3352
Practice Address - Street 1:9030 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-7741
Practice Address - Country:US
Practice Address - Phone:513-791-3336
Practice Address - Fax:513-791-3352
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-12
Last Update Date:2007-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSC 2420156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0721130001OtherSUPPLIER NUMBER