Provider Demographics
NPI:1205353844
Name:BASS, TIMOTHY E (OD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:E
Last Name:BASS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8313 S NC 55 HWY
Mailing Address - Street 2:
Mailing Address - City:WILLOW SPRING
Mailing Address - State:NC
Mailing Address - Zip Code:27592-9543
Mailing Address - Country:US
Mailing Address - Phone:919-639-2020
Mailing Address - Fax:919-516-0080
Practice Address - Street 1:2332 W CUMBERLAND ST
Practice Address - Street 2:
Practice Address - City:DUNN
Practice Address - State:NC
Practice Address - Zip Code:28334-6532
Practice Address - Country:US
Practice Address - Phone:910-897-2020
Practice Address - Fax:919-516-0080
Is Sole Proprietor?:No
Enumeration Date:2017-08-24
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2482152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist