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General NPI Number Information
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NPI Number | 1184143992
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Entity Type | Individual
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Provider Name | TIMOTHY DALLEY OD
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Gender | Male
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Dates
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Enumeration Date | 09/12/2017
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Last Update Date | 09/12/2017
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Provider Practice Location Address
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Address Line | 5401 MCPHERSON RD STE 13
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City | LAREDO
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State | TX
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Zip | 78041-6834
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Country | US
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Telephone | 956-704-5011
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Fax |
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Provider Business Mailing Address
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Address Line | 502 SHILOH DR APT 303W
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City | LAREDO
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State | TX
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Zip | 78045-6888
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Country | US
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Telephone | 918-718-9314
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 9350T
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License Number State | TX
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