Provider Demographics
NPI:1588930846
Name:TIMOTHY P. ANDERSON, O.D., P.A.
Entity type:Organization
Organization Name:TIMOTHY P. ANDERSON, O.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:828-692-2593
Mailing Address - Street 1:3450 ASHEVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28791-0701
Mailing Address - Country:US
Mailing Address - Phone:828-692-2593
Mailing Address - Fax:828-693-5558
Practice Address - Street 1:3450 ASHEVILLE HWY
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-0701
Practice Address - Country:US
Practice Address - Phone:828-692-2593
Practice Address - Fax:828-693-5558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1484152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890968AMedicaid
NC890968AMedicaid
NC2469207EMedicare PIN