Active NPI
Jack E Terry, O.D., PH.D.
- Optometrist
- Charlotte, NC
National Provider Identifier
1801340526
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 1469
- Practice address
- 200 S College St
Charlotte, NC 28202-2012 - Phone
- (704) 887-0824
- Fax
- (704) 332-9568
- NPI assigned
- Aug 10, 2016
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 1469 | NC | Primary |
| Optometrist | 152W00000X | 5608 | OH |
Addresses
Primary practice location
200 S College St
Charlotte, NC 28202-2012
Mailing address
200 S College St
Charlotte, NC 28202-2012
Phone (704) 887-0824
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 057645 | Other | NC | OE TRACKER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1469 | NC | MD | Addiction (Substance Use Disorder) Counselor |
| 5608 | OH | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1470787200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1470787200000",
"number": "1801340526",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 S COLLEGE ST",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282022012",
"telephone_number": "704-887-0824",
"fax_number": "704-332-9568"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 S COLLEGE ST",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282022012",
"telephone_number": "704-887-0824",
"fax_number": "704-332-9568"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TERRY",
"first_name": "JACK",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "O.D., PH.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-08-10",
"last_updated": "2016-08-10",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "NC",
"license": "1469",
"primary": true
},
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OH",
"license": "5608",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OE TRACKER",
"identifier": "057645",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.