Provider Demographics
NPI:1013353390
Name:POLING, TIMOTHY RAYMOND (OD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:RAYMOND
Last Name:POLING
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 1:511 ROANOKE BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-5032
Mailing Address - Country:US
Mailing Address - Phone:540-797-2780
Mailing Address - Fax:703-782-0220
Practice Address - Street 1:4822 VALLEY VIEW BLVD NW STE C
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24012-2046
Practice Address - Country:US
Practice Address - Phone:540-563-8279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-14
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001363152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist