Provider Demographics
NPI:1972358091
Name:FAIRHOPE TERREZZA GROUP OD PC
Entity Type:Organization
Organization Name:FAIRHOPE TERREZZA GROUP OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-434-2060
Mailing Address - Street 1:113 PALAFOX PL
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32502-5629
Mailing Address - Country:US
Mailing Address - Phone:850-434-2060
Mailing Address - Fax:850-429-8215
Practice Address - Street 1:101 FLY CREEK AVE STE 305
Practice Address - Street 2:
Practice Address - City:FAIRHOPE
Practice Address - State:AL
Practice Address - Zip Code:36532-8310
Practice Address - Country:US
Practice Address - Phone:850-434-2060
Practice Address - Fax:850-429-8215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty