Provider Demographics
NPI:1659395473
Name:CONNOR, TERRY WAYNE (OD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:WAYNE
Last Name:CONNOR
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 1:312 N CHANCERY ST
Mailing Address - Street 2:
Mailing Address - City:MCMINNVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37110-2048
Mailing Address - Country:US
Mailing Address - Phone:931-473-0890
Mailing Address - Fax:
Practice Address - Street 1:915 N CHANCERY ST
Practice Address - Street 2:STE 120
Practice Address - City:MC MINNVILLE
Practice Address - State:TN
Practice Address - Zip Code:37110-1504
Practice Address - Country:US
Practice Address - Phone:931-473-0890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNODT1737152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4006004OtherBLUE CROSS BLUE SHIELD TN
TN3941010Medicaid
TN3941010Medicaid
TNU64597Medicare UPIN