Provider Demographics
NPI:1851442107
Name:FOX, TIMOTHY W (OD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:W
Last Name:FOX
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 1:28 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1379
Mailing Address - Country:US
Mailing Address - Phone:610-332-2044
Mailing Address - Fax:610-332-2402
Practice Address - Street 1:28 E 3RD ST
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1379
Practice Address - Country:US
Practice Address - Phone:610-332-2044
Practice Address - Fax:610-332-2402
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2016-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOET009129152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAT30629Medicare UPIN
PA473159Medicare ID - Type Unspecified