Terry D. Moehnke, O.D., P.C.

Primary specialty

Eyewear SupplierTaxonomy code 332H00000X

License

1649 Issued in IA

Legal business name

TERRY D. MOEHNKE, O.D., P.C.

Practice address

25 S 16TH St
Fort Dodge, IA 50501-5021

Phone

(515) 955-6720

Fax

(515) 955-3555

NPI assigned

May 8, 2009

Last updated

Sep 24, 2010By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Terry D. Moehnke, O.D.NPI 1679567481

Title

President

Phone

(515) 955-6720

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in IA

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Terry Donn Moehnke, O.D.

  • Optometrist
  • Fort Dodge, IA
  • NPI 1679567481
  Medicare reassignment Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1241740800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285286400000",
    "number": "1619101326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25 S 16TH ST",
            "city": "FORT DODGE",
            "state": "IA",
            "postal_code": "505015021",
            "telephone_number": "515-955-6720",
            "fax_number": "515-955-3555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25 S 16TH ST",
            "city": "FORT DODGE",
            "state": "IA",
            "postal_code": "505015021",
            "telephone_number": "515-955-6720",
            "fax_number": "515-955-3555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TERRY D. MOEHNKE, O.D., P.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-08",
        "last_updated": "2010-09-24",
        "status": "A",
        "authorized_official_last_name": "MOEHNKE",
        "authorized_official_first_name": "TERRY",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "515-955-6720",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": "IA",
            "license": "1649",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0005843",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Eyewear Supplier in Fort Dodge, IA
• Providers in Fort Dodge, IA by specialty
• Eyewear Supplier in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.