Provider Demographics
NPI:1295890937
Name:MENNING, TERRY W (DR)
Entity type:Individual
Prefix:
First Name:TERRY
Middle Name:W
Last Name:MENNING
Suffix:
Gender:M
Credentials:DR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 1/2 N FIRST ST
Mailing Address - Street 2:
Mailing Address - City:GRANTS
Mailing Address - State:NM
Mailing Address - Zip Code:87020-2540
Mailing Address - Country:US
Mailing Address - Phone:505-287-4833
Mailing Address - Fax:
Practice Address - Street 1:215 1/2 N FIRST ST
Practice Address - Street 2:
Practice Address - City:GRANTS
Practice Address - State:NM
Practice Address - Zip Code:87020-2540
Practice Address - Country:US
Practice Address - Phone:505-287-4833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM202152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP8220Medicaid
NM33580OtherDAVIS
NM201006763OtherPRES
NM155767181OtherBCBS
NMT74946Medicare UPIN
NM201006763OtherPRES
NM6508750001Medicare NSC