=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871675850
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVID J THURMAN OD PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2006
-----------------------------------------------------
Last Update Date | 02/27/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 276 FREDERICK ST
-----------------------------------------------------
City | HANOVER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17331-3617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-637-6919
-----------------------------------------------------
Fax | 717-637-0726
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 276 FREDERICK ST
-----------------------------------------------------
City | HANOVER
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 17331-3617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 717-637-6919
-----------------------------------------------------
Fax | 717-637-0726
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DAVID J THURMAN
-----------------------------------------------------
Credential | OD
-----------------------------------------------------
Telephone | 717-637-6919
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OEG001137
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------