Provider Demographics
NPI:1013947811
Name:WOLF, TERRI A (DO)
Entity Type:Individual
Prefix:DR
First Name:TERRI
Middle Name:A
Last Name:WOLF
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1669 HAMILTON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OKEMOS
Mailing Address - State:MI
Mailing Address - Zip Code:48864-1956
Mailing Address - Country:US
Mailing Address - Phone:517-349-4743
Mailing Address - Fax:517-349-0096
Practice Address - Street 1:1669 HAMILTON RD
Practice Address - Street 2:SUITE 200
Practice Address - City:OKEMOS
Practice Address - State:MI
Practice Address - Zip Code:48864-1956
Practice Address - Country:US
Practice Address - Phone:517-349-4743
Practice Address - Fax:517-349-0096
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002650152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT32892Medicare UPIN
MIP26670001Medicare ID - Type Unspecified