Provider Demographics
NPI:1740270776
Name:VEILLON, TIMOTHY J (OD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:J
Last Name:VEILLON
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 1:2 MEDICAL CENTER BLVD
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3173
Mailing Address - Country:US
Mailing Address - Phone:936-634-8434
Mailing Address - Fax:936-639-2581
Practice Address - Street 1:2 MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3175
Practice Address - Country:US
Practice Address - Phone:936-634-8434
Practice Address - Fax:936-639-2581
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2766TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2766TGOtherTX LICENSE
TX112298803Medicaid
TX112298803Medicaid
TXT90855Medicare UPIN