Provider Demographics
NPI:1295929933
Name:TERREZZA, GENE (OD)
Entity type:Individual
Prefix:
First Name:GENE
Middle Name:
Last Name:TERREZZA
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 1:800 N FAIRFIELD DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-4313
Mailing Address - Country:US
Mailing Address - Phone:850-456-5059
Mailing Address - Fax:850-456-0461
Practice Address - Street 1:113 PALAFOX PL
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-5629
Practice Address - Country:US
Practice Address - Phone:850-456-5059
Practice Address - Fax:850-456-0461
Is Sole Proprietor?:No
Enumeration Date:2007-09-05
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC1196152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0503900002OtherMEDICARE DME
FL19770XMedicare PIN
FL0503900002OtherMEDICARE DME