Provider Demographics
NPI:1134107899
Name:NISBET, TERRY WILLIAM (OD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:WILLIAM
Last Name:NISBET
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 1:1351 E KEMPER RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-3903
Mailing Address - Country:US
Mailing Address - Phone:513-771-9800
Mailing Address - Fax:513-771-9840
Practice Address - Street 1:1351 E KEMPER RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-3903
Practice Address - Country:US
Practice Address - Phone:513-771-9800
Practice Address - Fax:513-771-9840
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4132152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000475686OtherANTHEM
OH0643225Medicare PIN
U27105Medicare UPIN