Provider Demographics
NPI:1689645764
Name:TURK, MARK LAYNE (OD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:LAYNE
Last Name:TURK
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 1:2378 US HIGHWAY 431
Mailing Address - Street 2:
Mailing Address - City:BOAZ
Mailing Address - State:AL
Mailing Address - Zip Code:35957-5905
Mailing Address - Country:US
Mailing Address - Phone:256-593-4141
Mailing Address - Fax:256-593-1899
Practice Address - Street 1:2378 US HIGHWAY 431
Practice Address - Street 2:
Practice Address - City:BOAZ
Practice Address - State:AL
Practice Address - Zip Code:35957-5905
Practice Address - Country:US
Practice Address - Phone:256-593-4141
Practice Address - Fax:256-593-1899
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-27
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-861-TA-420152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051079054Medicaid
AL051079054Medicaid
AL4333390001Medicare NSC