J. Terebuh MD Inc
Organization Active NPI Optometrist · Bellefontaine, OH
NPI 1194744102 · NPPES record last updated Apr 20, 2008
Key facts
- NPI
- 1194744102
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- Legal business name
- J. TEREBUH MD INC
- Practice address
- 1107 Rush Ave
Bellefontaine, OH 43311-9488 - Phone
- (937) 593-3881
- Fax
- (937) 593-3881
- NPI assigned
- Jul 19, 2006
- Organization subpart
- No
Authorized official
- Name
- Kristy Young
- Title
- MGR
- Phone
- (937) 593-3881
Practitioners 7
-
Courtney Y. Kauh, M.D.
-
Craig Charles McSurdy, O.D.
-
Janessa Marie Simon, O.D.
Laboratory certificates & supplier records
Medicare medical equipment & supply locations
| Supplier | Supplies | Medicare assignment |
|---|---|---|
| J. Terebuh MD Inc |
Prosthetic Lenses: Conventional Eyeglasses|Prosthetic Lenses: Conventional Contact Lenses | Accepts assignment |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in OH
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100301000069 | OH | Part B Supplier - Clinic/Group Practice | 0749183416 |
Receives reassigned benefits from 4 practitioners Practice locations: Bellefontaine, OH |
| O20100930013743 | OH | DME Supplier - Physician - Optometrist |
0749183416 | Practice locations: Bellefontaine, OH |
National Provider Directory
Locations
1107 Rush Ave
Unit 190
Bellefontaine, OH 43311
1107 Rush Ave
Ste 100
Bellefontaine, OH 43311
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | Yes | ||
| Ophthalmology Physician |
207W00000X |
Addresses
Primary practice location
1107 Rush Ave
Bellefontaine, OH 43311-9488
Mailing address
PO Box 190
1107 Rush Ave
Bellefontaine, OH 43311-0190
Phone (937) 593-3881
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CL3619 | Other | OH | RR GRP # |
Other providers in Bellefontaine, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 20, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.