Provider Demographics
NPI:1013979764
Name:MCKERNAN, TIMOTHY C (OD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:C
Last Name:MCKERNAN
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:105 BRANDT DR STE 201
Mailing Address - Street 2:SCOTT & CHRISTIE AND ASSOCIATES PC
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066
Mailing Address - Country:US
Mailing Address - Phone:724-772-5420
Mailing Address - Fax:724-772-5423
Practice Address - Street 1:105 BRANDT DR STE 201
Practice Address - Street 2:SCOTT & CHRISTIE AND ASSOCIATES PC
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-6412
Practice Address - Country:US
Practice Address - Phone:724-772-5420
Practice Address - Fax:724-772-5423
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOE006438T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA460993Medicare PIN
T30564Medicare UPIN