Provider Demographics
NPI:1861464216
Name:TURCOTT, RILEY J (OD)
Entity Type:Individual
Prefix:
First Name:RILEY
Middle Name:J
Last Name:TURCOTT
Suffix:
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 1:231 STATE ST
Mailing Address - Street 2:
Mailing Address - City:PETOSKEY
Mailing Address - State:MI
Mailing Address - Zip Code:49770-2785
Mailing Address - Country:US
Mailing Address - Phone:231-347-6151
Mailing Address - Fax:231-347-0541
Practice Address - Street 1:231 STATE ST
Practice Address - Street 2:
Practice Address - City:PETOSKEY
Practice Address - State:MI
Practice Address - Zip Code:49770-2785
Practice Address - Country:US
Practice Address - Phone:231-347-6151
Practice Address - Fax:231-347-0541
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-01
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002431152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIT32728Medicare UPIN
MI0B46506Medicare ID - Type Unspecified
MI0332060001Medicare NSC