Provider Demographics
NPI:1073798054
Name:DR JOE TERRY AND ASSOCIATES, INC
Entity Type:Organization
Organization Name:DR JOE TERRY AND ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:W
Authorized Official - Last Name:TERRY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:270-689-1901
Mailing Address - Street 1:5040 FREDERICA ST STE A
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-7425
Mailing Address - Country:US
Mailing Address - Phone:270-685-0247
Mailing Address - Fax:270-713-7932
Practice Address - Street 1:5040 FREDERICA ST STE A
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-7425
Practice Address - Country:US
Practice Address - Phone:270-685-0247
Practice Address - Fax:270-713-7932
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-08
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1395DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY77013951Medicaid
KY77013951Medicaid
KY1847701Medicare PIN