Provider Demographics
NPI:1093592933
Name:DR. TERRY L. BOLEN, OPTOMETRIST, PLLC
Entity Type:Organization
Organization Name:DR. TERRY L. BOLEN, OPTOMETRIST, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BOLEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:775-750-7542
Mailing Address - Street 1:PO BOX 122
Mailing Address - Street 2:
Mailing Address - City:HEWITT
Mailing Address - State:TX
Mailing Address - Zip Code:76643-0122
Mailing Address - Country:US
Mailing Address - Phone:254-339-1000
Mailing Address - Fax:
Practice Address - Street 1:600 HEWITT DR
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-6654
Practice Address - Country:US
Practice Address - Phone:254-339-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-13
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty