Organization
J. TEREBUH MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTY YOUNG (MGR)
(937) 593-3881
Entity
Organization
Contact information
Practice address
1107 RUSH AVE, BELLEFONTAINE, OH 43311-9488
(937) 593-3881
(937) 593-3881
Mailing address
PO BOX 190, 1107 RUSH AVE, BELLEFONTAINE, OH 43311-0190
(937) 593-3881
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
207W00000X
Ophthalmology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CL3619
RR GRP #
OH
Enumeration date
07/19/2006
Last updated
04/20/2008
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