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1700072360 NPI number — TIMOTHY JAY PERRY O.D.

NPI Number: 1700072360
Health Care Provider/Practitioner: TIMOTHY JAY PERRY O.D.

Information about “1700072360” NPI (TIMOTHY JAY PERRY O.D.) exists in 1700072360 in HTML format HTML  |  1700072360 in plain Text format TXT  |  1700072360 in PDF (Portable Document Format) PDF  |  1700072360 in an XML format XML  formats.

NPI Number : 1700072360 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1700072360",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "PERRY",
    "FirstName": "TIMOTHY",
    "MiddleName": "JAY",
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "O.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3856 STRATFORD CIR",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "VALDOSTA",
    "MailingAddressStateName": "GA",
    "MailingAddressPostalCode": "31605-4855",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "229-245-7227",
    "MailingAddressFaxNumber": "229-244-5287",
    "FirstLinePracticeLocationAddress": "120 BENJAMIN H HILL DR W",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "FITZGERALD",
    "PracticeLocationAddressStateName": "GA",
    "PracticeLocationAddressPostalCode": "31750-8607",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "229-563-7870",
    "PracticeLocationAddressFaxNumber": "229-244-5287",
    "EnumerationDate": "09/18/2007",
    "LastUpdateDate": "09/18/2007",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "152W00000X",
          "TaxonomyName": "Optometrist",
          "LicenseNumber": "OPT001635",
          "LicenseNumberStateCode": "GA",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "152W00000X",
          "TaxonomyName": "Optometrist",
          "LicenseNumber": "030/0000165",
          "LicenseNumberStateCode": "VT",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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