Provider Demographics
NPI:1073537320
Name:TURNER, JACK (OD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:
Last Name:TURNER
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 1:790 MONTCLAIR RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35213-1966
Mailing Address - Country:US
Mailing Address - Phone:205-592-3911
Mailing Address - Fax:205-592-3537
Practice Address - Street 1:790 MONTCLAIR RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35213-1966
Practice Address - Country:US
Practice Address - Phone:205-592-3911
Practice Address - Fax:205-592-3537
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-622-TA-335152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009913173Medicaid
AL009913173Medicaid
ALT69087Medicare UPIN
AL510I410025Medicare PIN