MEDICARE: DR. KENNETH ROBERT TURNER O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	NC859	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1790785129
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH ROBERT TURNER O.D.

Provider Business Mailing Address
First Line	:	7200 ALBEMARLE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28227-8110
Country	:	US
Telephone Number	:	704-568-2020
Fax Number	:	704-568-2030

Provider Business Practice Location Address
First Line	:	7200 ALBEMARLE RD
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28227-8110
Country	:	US
Telephone Number	:	704-568-2020
Fax Number	:	704-568-2030

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2005
Last Update Date	:	07/08/2007

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