Provider Demographics
NPI:1942223300
Name:DELLARIA-TERRILL, JULIA M (OD)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:M
Last Name:DELLARIA-TERRILL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:M
Other - Last Name:DELLARIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1110 PRAIRIE ST
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE DU SAC
Mailing Address - State:WI
Mailing Address - Zip Code:53578-2044
Mailing Address - Country:US
Mailing Address - Phone:608-643-3333
Mailing Address - Fax:608-644-3852
Practice Address - Street 1:1110 PRAIRIE ST
Practice Address - Street 2:
Practice Address - City:PRAIRIE DU SAC
Practice Address - State:WI
Practice Address - Zip Code:53578-2044
Practice Address - Country:US
Practice Address - Phone:608-643-3333
Practice Address - Fax:608-644-3852
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3054-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1942223300Medicaid
WIK400176123Medicare PIN
WIP01419992Medicare PIN
WI38630200Medicaid