Provider Demographics
NPI:1861460404
Name:STECKMAN, TERRY L (OD)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:L
Last Name:STECKMAN
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 1:62968 O B RILEY RD
Mailing Address - Street 2:STE#11
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-9442
Mailing Address - Country:US
Mailing Address - Phone:541-382-2020
Mailing Address - Fax:541-382-5004
Practice Address - Street 1:62968 O B RILEY RD
Practice Address - Street 2:STE#11
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-9442
Practice Address - Country:US
Practice Address - Phone:541-382-2020
Practice Address - Fax:541-382-5004
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1407AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR113447Medicare ID - Type Unspecified
T68161Medicare UPIN
ORR113448Medicare PIN