Provider Demographics
NPI:1356428791
Name:O'LEARY, TIMOTHY (OD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:O'LEARY
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 1:1233 HERSCHEL WOODS LN
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45208-4335
Mailing Address - Country:US
Mailing Address - Phone:513-321-2015
Mailing Address - Fax:513-321-8732
Practice Address - Street 1:1233 HERSCHEL WOODS LN
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45208-4335
Practice Address - Country:US
Practice Address - Phone:513-321-2015
Practice Address - Fax:513-321-8732
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2013-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3748 -- T582152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000017763OtherBLUE CROSS-BLUE SHIELD
OH374802OtherHUMANA
OH0804400Medicaid
OH000000017763OtherBLUE CROSS-BLUE SHIELD
OH374802OtherHUMANA
OHOL0669614Medicare ID - Type UnspecifiedMEDICARE-OHIO