Provider Demographics
NPI:1841320132
Name:HEACOX, TERRANCE KEITH JR (OD)
Entity type:Individual
Prefix:DR
First Name:TERRANCE
Middle Name:KEITH
Last Name:HEACOX
Suffix:JR
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 1:3071 E CHESTNUT AVE
Mailing Address - Street 2:SUITE B 6
Mailing Address - City:VINELAND
Mailing Address - State:NJ
Mailing Address - Zip Code:08361-7847
Mailing Address - Country:US
Mailing Address - Phone:856-205-1100
Mailing Address - Fax:856-205-9163
Practice Address - Street 1:3071 E CHESTNUT AVE
Practice Address - Street 2:SUITE B 6
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08361-7847
Practice Address - Country:US
Practice Address - Phone:856-205-1100
Practice Address - Fax:856-205-9163
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00581400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist