Provider Demographics
NPI:1881737906
Name:NOEL, TERRY (OD)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:
Last Name:NOEL
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 1:4057 DAUBERT DR
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-1831
Mailing Address - Country:US
Mailing Address - Phone:617-828-8033
Mailing Address - Fax:
Practice Address - Street 1:19 E ELIZABETH AVE
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-6520
Practice Address - Country:US
Practice Address - Phone:610-867-4522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2022-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2455TP152WC0802X
MA2455 TP152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW 16428OtherBLUE CROSS BLUE SHIELD
MAAA 51873OtherHARVARD PILGRIM
462261OtherTUFTS HEALTH PLAN
MAAA 51873OtherHARVARD PILGRIM
MAU08092Medicare UPIN