Provider Demographics
NPI:1437284635
Name:SWINGER, TERRENCE M (OD)
Entity Type:Individual
Prefix:DR
First Name:TERRENCE
Middle Name:M
Last Name:SWINGER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1137
Mailing Address - Street 2:
Mailing Address - City:CARUTHERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63830-1137
Mailing Address - Country:US
Mailing Address - Phone:573-333-1860
Mailing Address - Fax:573-333-0099
Practice Address - Street 1:101 E. TENTH ST.
Practice Address - Street 2:SUITE A
Practice Address - City:CARUTHERSVILLE
Practice Address - State:MO
Practice Address - Zip Code:63830
Practice Address - Country:US
Practice Address - Phone:573-333-1860
Practice Address - Fax:573-333-0099
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOT02094152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO4741012OtherBNDD
MO310150305Medicaid
MO310150305Medicaid
MOT42729Medicare UPIN