Healthcare Provider Details

I. General information

NPI: 1629065149
Provider Name (Legal Business Name): TIMOTHY W. EARLEY O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

888 MEMORIAL DR STE 201
OAKLAND MD
21550-5112
US

IV. Provider business mailing address

888 MEMORIAL DR
OAKLAND MD
21550-5112
US

V. Phone/Fax

Practice location:
  • Phone: 301-334-1146
  • Fax: 301-334-9729
Mailing address:
  • Phone: 301-334-1146
  • Fax: 301-334-9729

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4924/T1794
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number4924/T1794
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number4924/T1794
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number4924/T1794
License Number StateOH
# 5
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTA2997
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: