Provider Demographics
NPI:1467553040
Name:DR. GENE TERREZZA,O.D. & ASSOCIATES,P.A.
Entity Type:Organization
Organization Name:DR. GENE TERREZZA,O.D. & ASSOCIATES,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GENE
Authorized Official - Middle Name:
Authorized Official - Last Name:TERREZZA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:850-456-5059
Mailing Address - Street 1:800 N FAIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-4313
Mailing Address - Country:US
Mailing Address - Phone:850-456-5059
Mailing Address - Fax:850-456-0461
Practice Address - Street 1:800 N FAIRFIELD DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32506-4313
Practice Address - Country:US
Practice Address - Phone:850-456-5059
Practice Address - Fax:850-456-0461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1196152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4135BMedicare ID - Type UnspecifiedGRP#