Provider Demographics
NPI:1396789426
Name:TURETSKY, DAVID LAWRENCE (OD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:LAWRENCE
Last Name:TURETSKY
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 1:4439 MERLIN WAY
Mailing Address - Street 2:
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2340
Mailing Address - Country:US
Mailing Address - Phone:408-230-0290
Mailing Address - Fax:831-479-8718
Practice Address - Street 1:330 N BRAND BLVD
Practice Address - Street 2:SUITE 110
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-2308
Practice Address - Country:US
Practice Address - Phone:818-240-0890
Practice Address - Fax:818-246-2540
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT 7373 TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1396789426OtherMEDICAL PROVIDER
CA1306035118Medicaid
CA1396789426OtherMEDICAL PROVIDER
CAT10520Medicare UPIN
CA6191070001Medicare NSC
CAP00741249Medicare PIN
CABF531ZMedicare PIN
CADP2509Medicare PIN
CABR186Medicare PIN
CA1306035118Medicaid
CABR184Medicare PIN