Provider Demographics
NPI:1013907310
Name:TERRILL, MELISSA MCGOWAN (OD)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:MCGOWAN
Last Name:TERRILL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:MARIE
Other - Last Name:MCGOWAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:10 TOWER DR
Mailing Address - Street 2:
Mailing Address - City:SUN PRAIRIE
Mailing Address - State:WI
Mailing Address - Zip Code:53590-1239
Mailing Address - Country:US
Mailing Address - Phone:608-825-3008
Mailing Address - Fax:608-825-3794
Practice Address - Street 1:10 TOWER DR
Practice Address - Street 2:
Practice Address - City:SUN PRAIRIE
Practice Address - State:WI
Practice Address - Zip Code:53590-1239
Practice Address - Country:US
Practice Address - Phone:608-825-3008
Practice Address - Fax:608-825-3794
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2020-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3026-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1013907310Medicaid
WI60435OtherDEAN HEALTH INSURANCE
WI094974150Medicare PIN
V06881Medicare UPIN
WI38627300Medicaid