Provider Demographics
NPI:1598946964
Name:ARCH, TERRY L (OD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:L
Last Name:ARCH
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 1:2016 N WESTMORELAND DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-5746
Mailing Address - Country:US
Mailing Address - Phone:407-694-3228
Mailing Address - Fax:
Practice Address - Street 1:2016 N WESTMORELAND DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-5746
Practice Address - Country:US
Practice Address - Phone:407-694-3228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2223152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
19117Medicare PIN
T53949Medicare UPIN