Provider Demographics
NPI:1588650568
Name:TERRY, THOMAS F (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:F
Last Name:TERRY
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 1:128 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WHITE RIVER JUNCTION
Mailing Address - State:VT
Mailing Address - Zip Code:05001-7056
Mailing Address - Country:US
Mailing Address - Phone:802-295-3300
Mailing Address - Fax:802-295-6581
Practice Address - Street 1:128 N MAIN ST
Practice Address - Street 2:
Practice Address - City:WHITE RIVER JUNCTION
Practice Address - State:VT
Practice Address - Zip Code:05001-7056
Practice Address - Country:US
Practice Address - Phone:802-295-3300
Practice Address - Fax:802-295-6581
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2011-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT030-0000167152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
030264105OtherBANKER'S LIFE
NH0908741YOVT01OtherANTHEM
VTTEVT7953Medicaid
030264105OtherAARP
953283OtherMVP
030264105OtherCIGNA
030264105OtherVSP
VT0167OtherEYE MED
VTTEVT7959Medicare PIN
T25414Medicare UPIN
VTTEVT7953Medicare ID - Type Unspecified