Provider Demographics
NPI:1679661714
Name:TURLOCK EYECARE OPTOMETRIC CORPORATION
Entity Type:Organization
Organization Name:TURLOCK EYECARE OPTOMETRIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:J P
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:209-667-6211
Mailing Address - Street 1:2020 COLORADO AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-2002
Mailing Address - Country:US
Mailing Address - Phone:209-667-6211
Mailing Address - Fax:209-667-2574
Practice Address - Street 1:2020 COLORADO AVE
Practice Address - Street 2:SUITE A
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2002
Practice Address - Country:US
Practice Address - Phone:209-667-6211
Practice Address - Fax:209-667-2574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2009-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0311310003Medicare NSC