Provider Demographics
NPI:1639230121
Name:OVERHOLSER, TERRIE J (OD)
Entity Type:Individual
Prefix:
First Name:TERRIE
Middle Name:J
Last Name:OVERHOLSER
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 1:5353 SW COLLEGE RD
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34474-5717
Mailing Address - Country:US
Mailing Address - Phone:352-237-9451
Mailing Address - Fax:352-237-9479
Practice Address - Street 1:5353 SW COLLEGE RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-5717
Practice Address - Country:US
Practice Address - Phone:352-237-9451
Practice Address - Fax:352-237-9479
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2008-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOP2597152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL20413OtherBCBS OF FL
U40388Medicare UPIN
FL20413OtherBCBS OF FL