Provider Demographics
NPI:1467006536
Name:TURNER, TIMOTHY JERONE (DO)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JERONE
Last Name:TURNER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5809 HILLCREST CIR
Mailing Address - Street 2:
Mailing Address - City:INDIAN TRAIL
Mailing Address - State:NC
Mailing Address - Zip Code:28079-8652
Mailing Address - Country:US
Mailing Address - Phone:704-719-0999
Mailing Address - Fax:
Practice Address - Street 1:5809 HILLCREST CIR
Practice Address - Street 2:
Practice Address - City:INDIAN TRAIL
Practice Address - State:NC
Practice Address - Zip Code:28079-8652
Practice Address - Country:US
Practice Address - Phone:704-719-0999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-28
Last Update Date:2019-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1141156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician