Provider Demographics
NPI:1831627900
Name:THURMAN, KARLOTTA ALLYCE (OD)
Entity type:Individual
Prefix:DR
First Name:KARLOTTA
Middle Name:ALLYCE
Last Name:THURMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KARLOTTA
Other - Middle Name:ALLYCE
Other - Last Name:BUSHNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1530 N BROAD ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-2334
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:115 COLISEUM XING # 58
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-5971
Practice Address - Country:US
Practice Address - Phone:757-751-6236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-01
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1877-812AT152W00000X
VA0618002567152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist