Provider Demographics
NPI:1295876357
Name:THERIAULT TIMPERLEY, JULIE (OD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:
Last Name:THERIAULT TIMPERLEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JULIE
Other - Middle Name:
Other - Last Name:TIMPERLEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 464
Mailing Address - Street 2:
Mailing Address - City:GAYLORD
Mailing Address - State:MI
Mailing Address - Zip Code:49734-0464
Mailing Address - Country:US
Mailing Address - Phone:989-448-2325
Mailing Address - Fax:989-448-2326
Practice Address - Street 1:702 N CENTER AVE
Practice Address - Street 2:
Practice Address - City:GAYLORD
Practice Address - State:MI
Practice Address - Zip Code:49735-1508
Practice Address - Country:US
Practice Address - Phone:989-448-2325
Practice Address - Fax:989-448-2325
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004115152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI900F90023OtherBLUE CROSS BLUE SHIELD
MIU99647Medicare UPIN
MIMI3520001Medicare PIN