Provider Demographics
NPI:1942208384
Name:ODOM, TERRY D (MD)
Entity Type:Individual
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First Name:TERRY
Middle Name:D
Last Name:ODOM
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Gender:M
Credentials:MD
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Mailing Address - Street 1:800 MEMORIAL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:DANVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24541-1622
Mailing Address - Country:US
Mailing Address - Phone:434-799-3232
Mailing Address - Fax:434-792-5125
Practice Address - Street 1:800 MEMORIAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:DANVILLE
Practice Address - State:VA
Practice Address - Zip Code:24541-1622
Practice Address - Country:US
Practice Address - Phone:434-799-3232
Practice Address - Fax:434-792-5125
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-11
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
VA0101036781207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
B05824Medicare UPIN