Basic Information
| Provider Information | |||||||||
| NPI: | 1053318238 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAFNER | ||||||||
| FirstName: | TERRANCE | ||||||||
| MiddleName: | W | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 407 AVENUE K SE | ||||||||
| Address2: | |||||||||
| City: | WINTER HAVEN | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338804126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8632943504 | ||||||||
| FaxNumber: | 8632948305 | ||||||||
| Practice Location | |||||||||
| Address1: | 5032 US 27 N | ||||||||
| Address2: | |||||||||
| City: | SEBRING | ||||||||
| State: | FL | ||||||||
| PostalCode: | 338701354 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8633823900 | ||||||||
| FaxNumber: | 8633857442 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2005 | ||||||||
| LastUpdateDate: | 07/10/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OPC 2052 | FL | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.