Provider Demographics
NPI:1093121659
Name:TERRY, BRANDON NICHOLAS (OD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:NICHOLAS
Last Name:TERRY
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:9795 CROSSPOINT BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46256-3354
Mailing Address - Country:US
Mailing Address - Phone:317-254-6480
Mailing Address - Fax:317-259-8609
Practice Address - Street 1:1202 N LEBANON ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-1510
Practice Address - Country:US
Practice Address - Phone:765-482-1420
Practice Address - Fax:765-482-1461
Is Sole Proprietor?:No
Enumeration Date:2014-07-03
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN18003858A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist