Healthcare Provider Details

I. General information

NPI: 1891789780
Provider Name (Legal Business Name): MICHAEL E TURNER OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 06/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3315 S CAMPBELL AVE
SPRINGFIELD MO
65807-4914
US

IV. Provider business mailing address

2426 S BRANDON AVE
SPRINGFIELD MO
65809-3502
US

V. Phone/Fax

Practice location:
  • Phone: 417-887-1914
  • Fax: 417-887-1672
Mailing address:
  • Phone: 417-569-3473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2004019339
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: