Provider Demographics
NPI:1730074469
Name:TERRY, ISABELLA SUSANNE (OD)
Entity type:Individual
Prefix:DR
First Name:ISABELLA
Middle Name:SUSANNE
Last Name:TERRY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:54 ALAN DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-1902
Mailing Address - Country:US
Mailing Address - Phone:925-852-1672
Mailing Address - Fax:
Practice Address - Street 1:395 CIVIC DR STE G
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-1950
Practice Address - Country:US
Practice Address - Phone:925-676-8365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-11
Last Update Date:2025-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36006152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist