Provider Demographics
NPI:1750941225
Name:CONRAD, TERRI LYNN (OD)
Entity type:Individual
Prefix:
First Name:TERRI
Middle Name:LYNN
Last Name:CONRAD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1875 HIGHWAY 6 STE 800
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-5129
Mailing Address - Country:US
Mailing Address - Phone:281-980-3937
Mailing Address - Fax:281-313-0505
Practice Address - Street 1:1875 HIGHWAY 6 STE 800
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-5129
Practice Address - Country:US
Practice Address - Phone:281-980-3937
Practice Address - Fax:281-303-0505
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-17
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX04446152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1710172044OtherNPI
TX1417142621OtherNPI