Provider Demographics
NPI:1255312963
Name:THURMOND, GEORGE SHERMAN II (OD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:SHERMAN
Last Name:THURMOND
Suffix:II
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 1:5500 W FRIENDLY AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27410-4212
Mailing Address - Country:US
Mailing Address - Phone:336-292-4516
Mailing Address - Fax:336-292-5706
Practice Address - Street 1:5500 W FRIENDLY AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27410-4212
Practice Address - Country:US
Practice Address - Phone:336-292-4516
Practice Address - Fax:336-292-5706
Is Sole Proprietor?:No
Enumeration Date:2005-11-09
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1402152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890991KMedicaid
NC2468079Medicare PIN
NC890991KMedicaid