Provider Demographics
NPI:1124053152
Name:TURCIOS JR., ROBERT ANTHONY (OD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ANTHONY
Last Name:TURCIOS JR.
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:61 CHILPANCINGO PKWY
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-1300
Mailing Address - Country:US
Mailing Address - Phone:925-676-8365
Mailing Address - Fax:925-676-3382
Practice Address - Street 1:61 CHILPANCINGO PKWY
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-1300
Practice Address - Country:US
Practice Address - Phone:925-676-8365
Practice Address - Fax:925-676-3382
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7077T152W00000X, 152WC0802X, 152WL0500X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0070770Medicaid
CA7077TOtherSTATE LICENCE NUMBER
CA7077TOtherSTATE LICENCE NUMBER
CASD0070770Medicare PIN
CAT10467Medicare UPIN