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General NPI Number Information
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NPI Number | 1467670398
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Entity Type | Individual
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Provider Name | TIMOTHY MICHAEL SULT O.D.
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Gender | Male
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 09/12/2007
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Provider Practice Location Address
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Address Line | 6120 GLENWOOD AVE SUITE 104
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City | RALEIGH
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State | NC
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Zip | 27612-2614
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Country | US
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Telephone | 919-571-1366
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Fax | 919-571-7146
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Provider Business Mailing Address
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Address Line | 12828 LINDLEY DR
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City | RALEIGH
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State | NC
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Zip | 27614-8776
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Country | US
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Telephone | 919-841-0404
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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 | 1309
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License Number State | NC
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