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General NPI Number Information
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NPI Number | 1124634001
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Entity Type | Individual
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Provider Name | NATHAN TURNWALD OD
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Gender | Male
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Dates
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Enumeration Date | 09/16/2020
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Last Update Date | 09/26/2020
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Provider Practice Location Address
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Address Line | 8641 W FRANKLIN RD
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City | BOISE
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State | ID
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Zip | 83709-0632
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Country | US
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Telephone | 208-378-8989
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Fax |
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Provider Business Mailing Address
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Address Line | 1221 KRIEFT ST
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City | DELPHOS
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State | OH
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Zip | 45833-1331
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Country | US
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Telephone | 419-234-7234
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 100518
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License Number State | ID
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