Provider Demographics
NPI:1659478378
Name:TAYLOR, TERRI L (OD)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:L
Last Name:TAYLOR
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 1:1020 W BUENA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-5150
Mailing Address - Country:US
Mailing Address - Phone:812-423-3131
Mailing Address - Fax:812-426-7020
Practice Address - Street 1:1020 W BUENA VISTA RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-5150
Practice Address - Country:US
Practice Address - Phone:812-423-3131
Practice Address - Fax:812-426-7020
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003870A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1417DTOtherLICENSE
IN201249590Medicaid
000000211012OtherBCBS PROVIDER NUMBER
KY77014173Medicaid
0374726Medicare PIN
KY1417DTOtherLICENSE
IN201249590Medicaid
KY410042898Medicare PIN
0375225Medicare PIN
0375073Medicare PIN
000000211012OtherBCBS PROVIDER NUMBER
IN534080001Medicare PIN
0374625Medicare PIN
KY77014173Medicaid
0375323Medicare PIN