Provider Demographics
NPI:1811919764
Name:TURPIN, FRED S (OD)
Entity type:Individual
Prefix:
First Name:FRED
Middle Name:S
Last Name:TURPIN
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:PO BOX 729
Mailing Address - Street 2:
Mailing Address - City:DAWSON
Mailing Address - State:GA
Mailing Address - Zip Code:39842-0729
Mailing Address - Country:US
Mailing Address - Phone:229-995-3954
Mailing Address - Fax:229-995-3954
Practice Address - Street 1:226 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DAWSON
Practice Address - State:GA
Practice Address - Zip Code:39842-1420
Practice Address - Country:US
Practice Address - Phone:229-995-3954
Practice Address - Fax:229-995-3954
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-23
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA895T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000183488BMedicaid
GA000183488CMedicaid
GA000183488BMedicaid
GA55486454SAMedicare PIN
GA000183488BMedicaid
GA000183488CMedicaid