Healthcare Provider Details

I. General information

NPI: 1396789426
Provider Name (Legal Business Name): DAVID LAWRENCE TURETSKY O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 01/31/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 N BRAND BLVD SUITE 110
GLENDALE CA
91203-2308
US

IV. Provider business mailing address

4439 MERLIN WAY
SOQUEL CA
95073-2340
US

V. Phone/Fax

Practice location:
  • Phone: 818-240-0890
  • Fax: 818-246-2540
Mailing address:
  • Phone: 408-230-0290
  • Fax: 831-479-8718

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT 7373 TPA
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: