Provider Demographics
NPI:1821139411
Name:HAWLEY, TERRY WHITESIDES (OD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:WHITESIDES
Last Name:HAWLEY
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 1:827 DEEP VALLEY DR
Mailing Address - Street 2:SUITE 311
Mailing Address - City:ROLLING HILLS ESTATES
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3647
Mailing Address - Country:US
Mailing Address - Phone:310-541-3411
Mailing Address - Fax:310-541-6678
Practice Address - Street 1:827 DEEP VALLEY DR
Practice Address - Street 2:SUITE 311
Practice Address - City:ROLLING HILLS ESTATES
Practice Address - State:CA
Practice Address - Zip Code:90274-3647
Practice Address - Country:US
Practice Address - Phone:310-541-3411
Practice Address - Fax:310-541-6678
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6947T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU24690Medicare UPIN
CAWY209Medicare ID - Type Unspecified