Provider Demographics
NPI:1629120456
Name:THURN, MICHAEL DOUGLAS (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DOUGLAS
Last Name:THURN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3101 PGA BLVD
Mailing Address - Street 2:SUITE A101
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2820
Mailing Address - Country:US
Mailing Address - Phone:561-627-8185
Mailing Address - Fax:561-627-6456
Practice Address - Street 1:3101 PGA BLVD
Practice Address - Street 2:SUITE A101
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2820
Practice Address - Country:US
Practice Address - Phone:561-627-8185
Practice Address - Fax:561-627-6456
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 2131152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOPC 2131OtherSTATE LICENSE
FLU63421Medicare UPIN