Provider Demographics
NPI:1073500716
Name:JOSLIN, TERRY MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:MICHAEL
Last Name:JOSLIN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:103 E BANKHEAD ST
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652-3933
Mailing Address - Country:US
Mailing Address - Phone:662-534-5861
Mailing Address - Fax:662-534-2573
Practice Address - Street 1:103 E BANKHEAD ST
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652-3933
Practice Address - Country:US
Practice Address - Phone:662-534-5861
Practice Address - Fax:662-534-2573
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS513152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00087331Medicaid
MS00087331Medicaid
MS560000016Medicare ID - Type Unspecified
MS0613730001Medicare NSC