Provider Demographics
NPI:1336237676
Name:THURM, DANIEL W (OD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:W
Last Name:THURM
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 1:89 SHARON ST
Mailing Address - Street 2:
Mailing Address - City:STOUGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02072-2011
Mailing Address - Country:US
Mailing Address - Phone:781-344-3331
Mailing Address - Fax:781-344-4717
Practice Address - Street 1:89 SHARON ST
Practice Address - Street 2:
Practice Address - City:STOUGHTON
Practice Address - State:MA
Practice Address - Zip Code:02072-2011
Practice Address - Country:US
Practice Address - Phone:781-344-3331
Practice Address - Fax:781-344-4717
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3021152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0344729Medicaid
MA154615OtherTUFTS
MAW15803OtherBLUE CROSS BLUE SHIELD
U59400Medicare UPIN