MEDICARE: TIMOTHY JOHN MCAULIFFE 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	152WC0802X	Corneal and Contact Management Optometrist	636	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	86-0649146	OTHER	AZ	VISION SERVICE PLAN TAXID
2	AZ0636	OTHER	AZ	EYEMED PROVIDER #

General Provider Information

NPI Number	:	1811100761
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY JOHN MCAULIFFE O.D.

Provider Business Mailing Address
First Line	:	4015 EAST BELL ROAD
Second Line	:	SUITE # 136
City	:	PHOENIX
State	:	AZ
Zip	:	85032-2243
Country	:	US
Telephone Number	:	602-971-5858
Fax Number	:	602-404-1879

Provider Business Practice Location Address
First Line	:	4015 EAST BELL ROAD
Second Line	:	SUITE # 136
City	:	PHOENIX
State	:	AZ
Zip	:	85032-2243
Country	:	US
Telephone Number	:	602-971-5858
Fax Number	:	602-404-1879

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

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	03/07/2023

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