Provider Demographics
NPI:1972653483
Name:TURNER EYE INSTITUTE MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:TURNER EYE INSTITUTE MEDICAL GROUP, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-614-1515
Mailing Address - Street 1:420 ESTUDILLO AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4908
Mailing Address - Country:US
Mailing Address - Phone:510-614-1515
Mailing Address - Fax:510-614-1523
Practice Address - Street 1:420 ESTUDILLO AVE
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4908
Practice Address - Country:US
Practice Address - Phone:510-614-1515
Practice Address - Fax:510-357-6330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ18095ZOtherMEDICARE ID
CAZZZ18096ZOtherMEDICARE ID
CAZZZ18096ZOtherMEDICARE ID