Provider Demographics
NPI:1023101342
Name:TURNER, MICHAEL G (OD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:TURNER
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 1:1110 N LAMAR BLVD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:MS
Mailing Address - Zip Code:38655-2844
Mailing Address - Country:US
Mailing Address - Phone:662-234-0400
Mailing Address - Fax:662-234-0403
Practice Address - Street 1:1110 N LAMAR BLVD
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:MS
Practice Address - Zip Code:38655-2844
Practice Address - Country:US
Practice Address - Phone:662-234-0400
Practice Address - Fax:662-234-0403
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS595152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00880034Medicaid
MS00880034Medicaid