Provider Demographics
NPI:1407819212
Name:KLUGH, TIMOTHY RICHARD (OD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:RICHARD
Last Name:KLUGH
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 1:1730 CAROLINA AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:27889-3315
Mailing Address - Country:US
Mailing Address - Phone:252-946-2171
Mailing Address - Fax:252-946-5986
Practice Address - Street 1:1730 CAROLINA AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NC
Practice Address - Zip Code:27889-3315
Practice Address - Country:US
Practice Address - Phone:252-946-2171
Practice Address - Fax:252-946-5986
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2016-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1603152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC890903EMedicaid
NC0194WOtherBCBSN C
NC890903EMedicaid
NC249904BMedicare PIN
NC410034823Medicare PIN