Provider Demographics
NPI:1750361051
Name:TURNER, JOHN MCINTOSH (OD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MCINTOSH
Last Name:TURNER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-2609
Mailing Address - Country:US
Mailing Address - Phone:601-268-3937
Mailing Address - Fax:601-268-1375
Practice Address - Street 1:1100 S 28TH AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-2609
Practice Address - Country:US
Practice Address - Phone:601-268-3937
Practice Address - Fax:601-268-1375
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS441152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00087755Medicaid
MS56-0948150Medicare ID - Type UnspecifiedCAHABA
MS0608470001Medicare NSC
MST20893Medicare UPIN
MS00087755Medicaid