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General NPI Number Information
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NPI Number | 1972561306
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Entity Type | Individual
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Provider Name | TIMOTHY JAMES HENNIE O.D.
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Gender | Male
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 02/27/2013
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Provider Practice Location Address
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Address Line | 1910 JAKE ALEXANDER BLVD W SUITE 101
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City | SALISBURY
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State | NC
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Zip | 28147-1163
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Country | US
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Telephone | 704-633-2581
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Fax | 704-633-2592
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Provider Business Mailing Address
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Address Line | 1910 JAKE ALEXANDER BLVD W SUITE 101
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City | SALISBURY
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State | NC
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Zip | 28147-1162
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Country | US
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Telephone | 704-633-2581
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Fax | 704-633-2592
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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 | 1071
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License Number State | NC
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