Provider Demographics
NPI:1891874301
Name:METSOVAS, TERRY (OD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:
Last Name:METSOVAS
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:PO BOX 6512
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92863-6512
Mailing Address - Country:US
Mailing Address - Phone:714-637-9999
Mailing Address - Fax:714-637-9993
Practice Address - Street 1:2097 N TUSTIN ST
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92865-3901
Practice Address - Country:US
Practice Address - Phone:714-637-9999
Practice Address - Fax:714-637-9993
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT. 10460 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5302020001OtherDMERC
CA61327OtherSAFEGUARD PPO
CA9358503OtherPHCS
CA207199OtherEYEMED VISION
CA61328OtherSAFEGUARD HMO
CACA10460OtherVISION BENEFITS AMERICA
CASD01046T1OtherBLUE SHIELD
CA13607OtherMEDICAL EYE SERVICE
CA19173OtherCOAST TO COAST VISION
CASD0104600Medicaid
CAU83165Medicare UPIN
CAWOP10460AMedicare ID - Type UnspecifiedPPIN
CA61328OtherSAFEGUARD HMO