Provider Demographics
NPI:1770569345
Name:HAWKS, TERRY FOSTER (OD)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:FOSTER
Last Name:HAWKS
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 1:5703 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66207-2919
Mailing Address - Country:US
Mailing Address - Phone:913-341-4508
Mailing Address - Fax:913-341-4570
Practice Address - Street 1:5703 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66207-2919
Practice Address - Country:US
Practice Address - Phone:913-341-4508
Practice Address - Fax:913-341-4570
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1055-3152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100090500BMedicaid
KS0389400001Medicare NSC
KS410017322Medicare PIN
KST42361Medicare UPIN
KS100090500BMedicaid