MEDICARE: DR. TIMOTHY C MCKERNAN OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OE006438T	PA

General Provider Information

NPI Number	:	1013979764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY C MCKERNAN OD

Provider Business Mailing Address
First Line	:	105 BRANDT DR STE 201
Second Line	:	SCOTT & CHRISTIE AND ASSOCIATES PC
City	:	CRANBERRY TWP
State	:	PA
Zip	:	16066
Country	:	US
Telephone Number	:	724-772-5420
Fax Number	:	724-772-5423

Provider Business Practice Location Address
First Line	:	105 BRANDT DR STE 201
Second Line	:	SCOTT & CHRISTIE AND ASSOCIATES PC
City	:	CRANBERRY TWP
State	:	PA
Zip	:	16066-6412
Country	:	US
Telephone Number	:	724-772-5420
Fax Number	:	724-772-5423

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	04/19/2012

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