Terry S Mangold, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

WV718-OD Issued in WV

Practice address

1405 Chandell St
Keyser
Keyser, WV 26726-2012

Phone

(304) 788-5961

Fax

(304) 788-5961

NPI assigned

Jul 1, 2005

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1120176000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1218067200000",
    "number": "1689671877",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1405 CHANDELL ST",
            "address_2": "KEYSER",
            "city": "KEYSER",
            "state": "WV",
            "postal_code": "267262012",
            "telephone_number": "304-788-5961",
            "fax_number": "304-788-5961"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 CHANDELL ST",
            "address_2": "KEYSER",
            "city": "KEYSER",
            "state": "WV",
            "postal_code": "267262012",
            "telephone_number": "304-788-5961",
            "fax_number": "304-788-5961"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MANGOLD",
        "first_name": "TERRY",
        "middle_name": "S",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-07-01",
        "last_updated": "2008-08-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WV",
            "license": "WV718-OD",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAX ID #",
            "identifier": "550607791",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0150688000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAMSI HEALTH INSURANCE",
            "identifier": "257851",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda Lea Lusby
• Cassie Lynch
• M F Anwar MD Inc
• Hailey Maistros
• Lorraine S Mangold, MA, CCC-SLP
• Diann Manns
• Donna Jean Markelewicz
• Clarissa Kay Markle
• Connie Sue Markle
• Jodi Lea Markle

• Optometrist in Keyser, WV
• Providers in Keyser, WV by specialty
• Optometrist in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.