MEDICARE: DR. TIMOTHY MICHAEL FLAHERTY O.D.

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	2486	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1880048	OTHER	MN	MAYO
2	22-00932	OTHER	MN	MEDICA
3	19979	OTHER	MN	SPECTERA

General Provider Information

NPI Number	:	1477632057
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY MICHAEL FLAHERTY O.D.

Provider Business Mailing Address
First Line	:	205 STONEHENGE DR
Second Line	:
City	:	MANKATO
State	:	MN
Zip	:	56001-9334
Country	:	US
Telephone Number	:	507-345-6172
Fax Number	:

Provider Business Practice Location Address
First Line	:	1881 E MADISON AVE
Second Line	:
City	:	MANKATO
State	:	MN
Zip	:	56001-6200
Country	:	US
Telephone Number	:	507-388-9805
Fax Number	:	507-388-9812

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

Provider Enumeration Date	:	11/03/2006
Last Update Date	:	05/27/2008

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