1154440204 NPI number — CLIFFORD M TERRY M D INC

Table of content: (NPI 1154440204)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154440204 NPI number — CLIFFORD M TERRY M D INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLIFFORD M TERRY M D INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
TERRY EYE INSTITUTE
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154440204
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
270 LAGUNA RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
FULLERTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92835-2521
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-525-2375
Provider Business Mailing Address Fax Number:
714-871-9280

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
270 LAGUNA RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
FULLERTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92835-2521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-525-2375
Provider Business Practice Location Address Fax Number:
714-871-9280
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TERRY
Authorized Official First Name:
CLIFFORD
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OPHTHALMOLOGIST OWNER
Authorized Official Telephone Number:
714-525-2375

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1154440204 . This is a "NPI" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com