Provider Demographics
NPI:1245206440
Name:OCONNOR, TIMOTHY ALBERT (OD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ALBERT
Last Name:OCONNOR
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BROOKFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01535
Mailing Address - Country:US
Mailing Address - Phone:508-867-3755
Mailing Address - Fax:
Practice Address - Street 1:355 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH BROOKFIELD
Practice Address - State:MA
Practice Address - Zip Code:01535
Practice Address - Country:US
Practice Address - Phone:508-867-3755
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3786152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9777385Medicaid
MA93786OtherVISION BENEFITS OF AMERIC
MA3786OtherEYE MED
043296176001OtherTRICARE
14021OtherMOC
7617OtherDAVIS VISION
20799OtherCIGNA HEALTH CARE
2634580OtherAETNA US HEALTH CARE
W20119OtherBCBS
MA0392006Medicaid
2203019OtherUNITED HEALTH PLANS OF NE
57106OtherTRICARE
152068OtherHARVARD PILGRIM HEALTH CA
5088673755OtherVISION SERVICE PLAN
14021OtherMOC
MA9777385Medicaid