MEDICARE: THOMAS TURTLE OPTICIANS INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	NY5265	NY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0597890001	OTHER		MEDICARE DME
2	0597890003	OTHER		MEDICARE DME
10	0597890002	OTHER		MEDICARE DME
11	0597890004	OTHER	NY	MEDICARE DME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
3	00025972201	OTHER	UNIVERA
4	000300010003	OTHER	BCBS
5	000300010001	OTHER	BCBS
6	NY5265	OTHER	EYEMED
7	000300010007	OTHER	BCBS
8	000300010005	OTHER	BCBS
9	7309539	OTHER	INDEPENDENT HEALTH

General Provider Information

NPI Number	:	1396878765
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THOMAS TURTLE OPTICIANS INC.

Provider Business Mailing Address
First Line	:	444 PAYNE AVE
Second Line	:	P.O. BOX 830
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-6902
Country	:	US
Telephone Number	:	716-693-1280
Fax Number	:	716-693-1383

Provider Business Practice Location Address
First Line	:	444 PAYNE AVE
Second Line	:
City	:	NORTH TONAWANDA
State	:	NY
Zip	:	14120-6902
Country	:	US
Telephone Number	:	716-693-1280
Fax Number	:	716-693-1383

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DAVID T TURTLE
Credential	:	O.D.
Telephone Number	:	716-693-1280

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	12/13/2007

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