Individual provider Active NPI

Isabella Susanne Terry, OD

  • Optometrist
  • Pleasant Hill, CA
National Provider Identifier
1730074469
Registry record updated Jun 11, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
36006 Issued in CA
Practice address
395 Civic Dr Ste G
Pleasant Hill, CA 94523-1950
Phone
(925) 676-8365
NPI assigned
Jun 11, 2025
Last updated
Jun 11, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 11, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 36006 CA Primary

Addresses

Primary practice location

395 Civic Dr Ste G
Pleasant Hill, CA 94523-1950

Mailing address

54 Alan Dr
Pleasant Hill, CA 94523-1902
Phone (925) 852-1672

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250701002044 CA Order and Referring Only - OptometryPractitioner - Optometry 8729591912

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
36006CAMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Etwaru Eye Center PastSince Jun 15, 2025 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1749600000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749600000000",
    "number": "1730074469",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "54 ALAN DR",
            "city": "PLEASANT HILL",
            "state": "CA",
            "postal_code": "945231902",
            "telephone_number": "925-852-1672"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "395 CIVIC DR STE G",
            "city": "PLEASANT HILL",
            "state": "CA",
            "postal_code": "945231950",
            "telephone_number": "925-676-8365"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TERRY",
        "first_name": "ISABELLA",
        "middle_name": "SUSANNE",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-06-11",
        "last_updated": "2025-06-11",
        "certification_date": "2025-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "36006",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pleasant Hill, CA

Sources for this page

Verify at the official NPI Registry.