Provider Demographics
NPI:1457462012
Name:ONEBY, TERRI DAWN (OD)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:DAWN
Last Name:ONEBY
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 1:1950 OLD GALLOWS RD STE 300
Mailing Address - Street 2:
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3977
Mailing Address - Country:US
Mailing Address - Phone:703-847-8899
Mailing Address - Fax:571-223-6780
Practice Address - Street 1:1645 28TH ST
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1001
Practice Address - Country:US
Practice Address - Phone:505-828-4923
Practice Address - Fax:505-213-0103
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM417152W00000X
COOPT.0001580152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM87280787Medicaid
NMP01503322OtherRAILROAD MEDICARE - PALMETTO GBA
NM363428YTQZMedicare PIN