Provider Demographics
NPI:1780857045
Name:DECECCA, TERRI K (OPTICIAN)
Entity Type:Individual
Prefix:MRS
First Name:TERRI
Middle Name:K
Last Name:DECECCA
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 CALEF HWY
Mailing Address - Street 2:
Mailing Address - City:EPPING
Mailing Address - State:NH
Mailing Address - Zip Code:03042-2326
Mailing Address - Country:US
Mailing Address - Phone:603-679-1880
Mailing Address - Fax:603-679-1820
Practice Address - Street 1:237 CALEF HWY
Practice Address - Street 2:
Practice Address - City:EPPING
Practice Address - State:NH
Practice Address - Zip Code:03042-2326
Practice Address - Country:US
Practice Address - Phone:603-679-1880
Practice Address - Fax:603-679-1820
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH835156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30753100Medicaid