Provider Demographics
NPI:1629240437
Name:DR. TERRY M. JOSLIN
Entity Type:Organization
Organization Name:DR. TERRY M. JOSLIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRY
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOSLIN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:662-534-5861
Mailing Address - Street 1:103 E BANKHEAD ST
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:MS
Mailing Address - Zip Code:38652-3933
Mailing Address - Country:US
Mailing Address - Phone:662-534-5861
Mailing Address - Fax:662-534-2573
Practice Address - Street 1:103 EAST BANKHEAD ST.
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652
Practice Address - Country:US
Practice Address - Phone:662-534-5861
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOSLIN EYE CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-04-01
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS513152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0613730001Medicare NSC