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General NPI Number Information
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NPI Number | 1629205604
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Entity Type | Organization
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Legal Business Name | TIMOTHY J. GRACE O.D.,P.C.
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Dates
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Enumeration Date | 06/17/2009
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Last Update Date | 06/17/2009
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Provider Practice Location Address
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Address Line | 548 W 3RD ST
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City | JAMESTOWN
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State | NY
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Zip | 14701-4733
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Country | US
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Telephone | 716-488-1148
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Fax | 716-488-0047
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Provider Business Mailing Address
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Address Line | 548 W 3RD ST
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City | JAMESTOWN
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State | NY
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Zip | 14701-4733
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Country | US
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Telephone | 716-488-1148
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Fax | 716-488-0047
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | TIMOTHY J. GRACE
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Credential | O.D.
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Telephone | 716-488-1148
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | TUV004521-1
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License Number State | NY
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