Healthcare Provider Details

I. General information

NPI: 1972653483
Provider Name (Legal Business Name): TURNER EYE INSTITUTE MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 08/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 ESTUDILLO AVE
SAN LEANDRO CA
94577-4908
US

IV. Provider business mailing address

420 ESTUDILLO AVE
SAN LEANDRO CA
94577-4908
US

V. Phone/Fax

Practice location:
  • Phone: 510-614-1515
  • Fax: 510-357-6330
Mailing address:
  • Phone: 510-614-1515
  • Fax: 510-614-1523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN G TURNER
Title or Position: OWNER
Credential: M.D.
Phone: 510-614-1515