Healthcare Provider Details

I. General information

NPI: 1245234715
Provider Name (Legal Business Name): TIMOTHY R BYRNES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 08/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5296 PETERS CREEK RD
ROANOKE VA
24019-3808
US

IV. Provider business mailing address

PO BOX 1789
ROANOKE VA
24008-1789
US

V. Phone/Fax

Practice location:
  • Phone: 540-855-5100
  • Fax:
Mailing address:
  • Phone: 540-855-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number0101230571
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number0101230571
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: