Healthcare Provider Details

I. General information

NPI: 1073523007
Provider Name (Legal Business Name): TURLOCK EYE PHYSICIANS MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 05/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

880 DELBON AVE
TURLOCK CA
95382-2005
US

IV. Provider business mailing address

880 DELBON AVE
TURLOCK CA
95382-2005
US

V. Phone/Fax

Practice location:
  • Phone: 209-634-2925
  • Fax: 209-634-9169
Mailing address:
  • Phone: 209-634-2925
  • Fax: 209-634-9169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberGR0064380
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State

VIII. Authorized Official

Name: DANIEL LEE
Title or Position: OWNER / PARTNER
Credential: MD
Phone: 209-634-2925