Provider Demographics
NPI:1639406671
Name:TIMOTHY J. MCAULIFFE, O.D., P.C.
Entity Type:Organization
Organization Name:TIMOTHY J. MCAULIFFE, O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:MCAULIFFE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:602-971-5858
Mailing Address - Street 1:P.O. BOX 1379
Mailing Address - Street 2:7275 EASY STREET SUITE A-106
Mailing Address - City:CAREFREE
Mailing Address - State:AZ
Mailing Address - Zip Code:85377-1379
Mailing Address - Country:US
Mailing Address - Phone:480-488-7071
Mailing Address - Fax:480-488-2974
Practice Address - Street 1:7275 EASY STREET
Practice Address - Street 2:SUITE A-106
Practice Address - City:CAREFREE
Practice Address - State:AZ
Practice Address - Zip Code:85377-1379
Practice Address - Country:US
Practice Address - Phone:480-488-7071
Practice Address - Fax:480-488-2974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ636152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZOD636AMedicare PIN
AZOD636AMedicare UPIN