Provider Demographics
NPI:1003022377
Name:CYR, TERRI L (DR OD)
Entity Type:Individual
Prefix:DR
First Name:TERRI
Middle Name:L
Last Name:CYR
Suffix:
Gender:F
Credentials:DR OD
Other - Prefix:MRS
Other - First Name:TERRI
Other - Middle Name:
Other - Last Name:BEBRIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:61 IDLEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:CT
Mailing Address - Zip Code:06716
Mailing Address - Country:US
Mailing Address - Phone:203-879-4919
Mailing Address - Fax:203-265-0415
Practice Address - Street 1:930 N COLONY RD
Practice Address - Street 2:SUITE I
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2471
Practice Address - Country:US
Practice Address - Phone:203-265-4362
Practice Address - Fax:203-265-0415
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2008-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2264152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004101828Medicaid
CT004101828Medicaid
CT410000539Medicare ID - Type Unspecified