1245206440 NPI number — DR. TIMOTHY ALBERT OCONNOR OD

Table of content: KIMBERLY FELICETTI FNP (NPI 1467800086)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245206440 NPI number — DR. TIMOTHY ALBERT OCONNOR OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OCONNOR
Provider First Name:
TIMOTHY
Provider Middle Name:
ALBERT
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245206440
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
355 N MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH BROOKFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01535
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-867-3755
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
355 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH BROOKFIELD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01535
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-867-3755
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  3786 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9777385 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: MA93786 . This is a "VISION BENEFITS OF AMERIC" identifier . This identifiers is of the category "OTHER".
  • Identifier: MA3786 . This is a "EYE MED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 043296176001 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 14021 . This is a "MOC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7617 . This is a "DAVIS VISION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 20799 . This is a "CIGNA HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2634580 . This is a "AETNA US HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: W20119 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0392006 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2203019 . This is a "UNITED HEALTH PLANS OF NE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 57106 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 152068 . This is a "HARVARD PILGRIM HEALTH CA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5088673755 . This is a "VISION SERVICE PLAN" identifier . This identifiers is of the category "OTHER".




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