Provider Demographics
NPI:1003995119
Name:TURK, BETSY ANN (OD)
Entity Type:Individual
Prefix:
First Name:BETSY
Middle Name:ANN
Last Name:TURK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 WEST 40TH STREET
Mailing Address - Street 2:
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68845
Mailing Address - Country:US
Mailing Address - Phone:308-234-4007
Mailing Address - Fax:
Practice Address - Street 1:5411 2ND AVENUE
Practice Address - Street 2:
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847
Practice Address - Country:US
Practice Address - Phone:308-234-4991
Practice Address - Fax:308-234-5692
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1074152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE1002505070Medicaid
U59730Medicare UPIN