Healthcare Provider Details

I. General information

NPI: 1245206440
Provider Name (Legal Business Name): TIMOTHY ALBERT OCONNOR OD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 N MAIN ST
NORTH BROOKFIELD MA
01535
US

IV. Provider business mailing address

355 N MAIN ST
NORTH BROOKFIELD MA
01535
US

V. Phone/Fax

Practice location:
  • Phone: 508-867-3755
  • Fax:
Mailing address:
  • Phone: 508-867-3755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3786
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: