=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134124704
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID THOMAS TURTLE O.D.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2005
-----------------------------------------------------
Last Update Date | 11/23/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 444 PAYNE AVE
-----------------------------------------------------
City | NORTH TONAWANDA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14120-6902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-693-1280
-----------------------------------------------------
Fax | 716-693-1383
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 444 PAYNE AVE
-----------------------------------------------------
City | NORTH TONAWANDA
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 14120-6902
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 716-693-1280
-----------------------------------------------------
Fax | 716-693-1383
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | VUT005265
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------