Provider Demographics
NPI:1366445819
Name:NEAL, TERRY LEE (OD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:LEE
Last Name:NEAL
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 1:3236 LITTLE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:TRINITY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1865
Mailing Address - Country:US
Mailing Address - Phone:727-236-8797
Mailing Address - Fax:
Practice Address - Street 1:3236 LITTLE RD STE 1
Practice Address - Street 2:
Practice Address - City:TRINITY
Practice Address - State:FL
Practice Address - Zip Code:34655-1865
Practice Address - Country:US
Practice Address - Phone:727-236-8797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-28
Last Update Date:2018-03-27
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-24
Provider Licenses
StateLicense IDTaxonomies
FLOPC2087152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078314500Medicaid
FL19711Medicare ID - Type Unspecified
FL078314500Medicaid