Provider Demographics
NPI:1447262431
Name:KEY, TERRY ALLEN
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:ALLEN
Last Name:KEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4352 DUVAL ST
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-2169
Mailing Address - Country:US
Mailing Address - Phone:352-684-7684
Mailing Address - Fax:
Practice Address - Street 1:1202 S BROAD ST
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34601-3132
Practice Address - Country:US
Practice Address - Phone:352-796-0340
Practice Address - Fax:352-796-0340
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDO5367156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician