Provider Demographics
NPI:1548969132
Name:OLIVER, TERRY A
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:A
Last Name:OLIVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5303 BOWEN DR
Mailing Address - Street 2:
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040-6732
Mailing Address - Country:US
Mailing Address - Phone:513-770-4178
Mailing Address - Fax:513-770-4187
Practice Address - Street 1:5303 BOWEN DR
Practice Address - Street 2:
Practice Address - City:MASON
Practice Address - State:OH
Practice Address - Zip Code:45040-6732
Practice Address - Country:US
Practice Address - Phone:513-770-4178
Practice Address - Fax:513-770-4187
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOP003978-SC156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHOP.3978-SCMedicaid