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General NPI Number Information
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NPI Number | 1265533327
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Entity Type | Organization
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Legal Business Name | TIMOTHY J. PERRY, O.D., P.C.
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 09/18/2007
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Provider Practice Location Address
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Address Line | 120 BENJAMIN H HILL DR W
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City | FITZGERALD
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State | GA
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Zip | 31750-8607
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Country | US
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Telephone | 229-423-0159
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Fax | 229-423-0165
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Provider Business Mailing Address
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Address Line | 3856 STRATFORD CIR
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City | VALDOSTA
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State | GA
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Zip | 31605-4855
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Country | US
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Telephone | 229-245-7227
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Fax | 229-244-5287
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TIMOTHY JAY PERRY
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Credential | O.D.
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Telephone | 229-245-7227
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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 | 030/0000165
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License Number State | VT
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT001635
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License Number State | GA
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