Provider Demographics
NPI:1649571035
Name:TERRY, ALISON (OD)
Entity Type:Individual
Prefix:DR
First Name:ALISON
Middle Name:
Last Name:TERRY
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 1:4141 EASTON LOOP E
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43219-6176
Mailing Address - Country:US
Mailing Address - Phone:614-418-0347
Mailing Address - Fax:614-418-0367
Practice Address - Street 1:4141 EASTON LOOP E
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-6176
Practice Address - Country:US
Practice Address - Phone:614-418-0347
Practice Address - Fax:614-418-0367
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-16
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007648152W00000X
OH5997152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0169717Medicaid