Healthcare Provider Details

I. General information

NPI: 1437284635
Provider Name (Legal Business Name): TERRENCE M SWINGER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 E. TENTH ST. SUITE A
CARUTHERSVILLE MO
63830
US

IV. Provider business mailing address

PO BOX 1137
CARUTHERSVILLE MO
63830-1137
US

V. Phone/Fax

Practice location:
  • Phone: 573-333-1860
  • Fax: 573-333-0099
Mailing address:
  • Phone: 573-333-1860
  • Fax: 573-333-0099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberT02094
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: