MEDICARE: LEONARD M THURSCHWELL OD

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	000928	GA

General Provider Information

NPI Number	:	1881696763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEONARD M THURSCHWELL OD

Provider Business Mailing Address
First Line	:	895 CANTON RD NE
Second Line	:	BUILDING 100
City	:	MARIETTA
State	:	GA
Zip	:	30060-8934
Country	:	US
Telephone Number	:	770-427-8111
Fax Number	:	770-499-1643

Provider Business Practice Location Address
First Line	:	1230 JOHNSON FERRY PL
Second Line	:	SUITE B-10
City	:	MARIETTA
State	:	GA
Zip	:	30068-2048
Country	:	US
Telephone Number	:	770-977-8000
Fax Number	:	770-977-5541

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/11/2005
Last Update Date	:	07/08/2007

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