Provider Demographics
NPI:1578636700
Name:TIMOTHY J. MORRISON, OD, PC
Entity Type:Organization
Organization Name:TIMOTHY J. MORRISON, OD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:MORRISON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:708-599-9095
Mailing Address - Street 1:8605 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:HICKORY HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60457-2704
Mailing Address - Country:US
Mailing Address - Phone:708-599-9095
Mailing Address - Fax:708-233-9866
Practice Address - Street 1:8605 W 95TH ST
Practice Address - Street 2:
Practice Address - City:HICKORY HILLS
Practice Address - State:IL
Practice Address - Zip Code:60457-2704
Practice Address - Country:US
Practice Address - Phone:708-599-9095
Practice Address - Fax:708-233-9866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008092152W00000X
IL046-008092332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332H00000XSuppliersEyewear Supplier
No152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL356000Medicare PIN
ILT36545Medicare UPIN
IL1008120001Medicare NSC
ILIL3290Medicare PIN