Provider Demographics
NPI:1407927007
Name:ADKINS, TERRY LYNN (OD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:LYNN
Last Name:ADKINS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13301 HALL RD
Mailing Address - Street 2:SHELBY CORNERS
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48315-5835
Mailing Address - Country:US
Mailing Address - Phone:586-286-8275
Mailing Address - Fax:586-286-1019
Practice Address - Street 1:334 JOHN R RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-4542
Practice Address - Country:US
Practice Address - Phone:248-585-5830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002780152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN34040021Medicare ID - Type Unspecified
MIU11079Medicare UPIN