Provider Demographics
NPI:1558357343
Name:TURRENTINE, THOMAS JOHN IV (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOHN
Last Name:TURRENTINE
Suffix:IV
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:70 WESTCARE DR
Mailing Address - Street 2:STE 403
Mailing Address - City:SYLVA
Mailing Address - State:NC
Mailing Address - Zip Code:28779-5292
Mailing Address - Country:US
Mailing Address - Phone:828-586-7462
Mailing Address - Fax:828-586-3312
Practice Address - Street 1:70 WESTCARE DR
Practice Address - Street 2:STE 403
Practice Address - City:SYLVA
Practice Address - State:NC
Practice Address - Zip Code:28779-5292
Practice Address - Country:US
Practice Address - Phone:828-586-7462
Practice Address - Fax:828-586-3312
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC904152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8909926Medicaid
T64765Medicare UPIN
NC8909926Medicaid