MEDICARE: TERRY DONN MOEHNKE O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1649	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1679567481
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERRY DONN MOEHNKE O.D.

Provider Business Mailing Address
First Line	:	25 S 16TH ST
Second Line	:
City	:	FORT DODGE
State	:	IA
Zip	:	50501-5021
Country	:	US
Telephone Number	:	515-955-6720
Fax Number	:	515-955-3555

Provider Business Practice Location Address
First Line	:	25 S 16TH ST
Second Line	:
City	:	FORT DODGE
State	:	IA
Zip	:	50501-5021
Country	:	US
Telephone Number	:	515-955-6720
Fax Number	:	515-955-3555

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/07/2005
Last Update Date	:	02/27/2014

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