Provider Demographics
NPI:1255339073
Name:ISBILL, TERRY KENT (OD)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:KENT
Last Name:ISBILL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 GRAND AVE
Mailing Address - Street 2:STE B
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95838-3466
Mailing Address - Country:US
Mailing Address - Phone:916-927-3773
Mailing Address - Fax:916-927-8304
Practice Address - Street 1:811 GRAND AVE
Practice Address - Street 2:STE B
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95838-3466
Practice Address - Country:US
Practice Address - Phone:916-927-3773
Practice Address - Fax:916-927-8304
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA5085T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0050850Medicaid
CA0407750001Medicare NSC
CAT09868Medicare UPIN