MEDICARE: DR. TIMOTHY MARTIN MORAND 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	3429/T953	OH

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
2	759788	OTHER	OH	BWC PROVIDER NUMBER

General Provider Information

NPI Number	:	1770543936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIMOTHY MARTIN MORAND O.D.

Provider Business Mailing Address
First Line	:	3200 VINE ST
Second Line	:	VAMC CINCINNATI
City	:	CINCINNATI
State	:	OH
Zip	:	45220-2213
Country	:	US
Telephone Number	:	513-861-3100
Fax Number	:	513-475-4469

Provider Business Practice Location Address
First Line	:	3200 VINE ST
Second Line	:	VAMC CINCINNATI
City	:	CINCINNATI
State	:	OH
Zip	:	45220-2213
Country	:	US
Telephone Number	:	513-861-3100
Fax Number	:	513-475-4469

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

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	10/10/2008

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