Provider Demographics
NPI:1699745125
Name:HUSEMAN, TERRY DUANE (OD)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:DUANE
Last Name:HUSEMAN
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 1:3800 MERLE HAY RD
Mailing Address - Street 2:SUITE 501
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50310-1305
Mailing Address - Country:US
Mailing Address - Phone:515-278-1653
Mailing Address - Fax:515-278-0043
Practice Address - Street 1:3800 MERLE HAY RD
Practice Address - Street 2:SUITE 501
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50310-1305
Practice Address - Country:US
Practice Address - Phone:515-278-1653
Practice Address - Fax:515-278-0043
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA1834152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
58491Medicare ID - Type Unspecified
T65206Medicare UPIN