Healthcare Provider Details

I. General information

NPI: 1649067729
Provider Name (Legal Business Name): AUTOTELIC PROPERTIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2025
Last Update Date: 07/17/2025
Certification Date: 07/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

938 EISENHOWER BLVD
JOHNSTOWN PA
15904-3319
US

IV. Provider business mailing address

938 EISENHOWER BLVD
JOHNSTOWN PA
15904-3319
US

V. Phone/Fax

Practice location:
  • Phone: 814-270-6045
  • Fax:
Mailing address:
  • Phone: 814-270-6045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TIM ARLOW
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 814-270-6045