MEDICARE: DR. TIMOTHY P. ALLEN O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1968TG	TX

General Provider Information

NPI Number	:	1770569444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY P. ALLEN O.D.

Provider Business Mailing Address
First Line	:	4118 CACTUS OAK RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-4302
Country	:	US
Telephone Number	:	210-521-4341
Fax Number	:

Provider Business Practice Location Address
First Line	:	4118 CACTUS OAK RD
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78251-4302
Country	:	US
Telephone Number	:	210-521-4341
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/15/2005
Last Update Date	:	07/08/2007

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