MEDICARE: DR. TIMOTHY W TOLFORD 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	OPT637	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063401578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY W TOLFORD OD

Provider Business Mailing Address
First Line	:	PO BOX 7487
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04112-7487
Country	:	US
Telephone Number	:	207-885-8686
Fax Number	:	207-883-7154

Provider Business Practice Location Address
First Line	:	770 CONGRESS ST
Second Line	:
City	:	PORTLAND
State	:	ME
Zip	:	04102-3323
Country	:	US
Telephone Number	:	207-772-8384
Fax Number	:	207-773-0020

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

Provider Enumeration Date	:	10/18/2005
Last Update Date	:	01/17/2012

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