Provider Demographics
NPI:1770543936
Name:MORAND, TIMOTHY MARTIN (OD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:MARTIN
Last Name:MORAND
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 1:3200 VINE ST
Mailing Address - Street 2:VAMC CINCINNATI
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45220-2213
Mailing Address - Country:US
Mailing Address - Phone:513-861-3100
Mailing Address - Fax:513-475-4469
Practice Address - Street 1:3200 VINE ST
Practice Address - Street 2:VAMC CINCINNATI
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-2213
Practice Address - Country:US
Practice Address - Phone:513-861-3100
Practice Address - Fax:513-475-4469
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3429/T953152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0434051Medicaid
OH759788OtherBWC PROVIDER NUMBER
OH0434051Medicaid
OH0510751Medicare ID - Type Unspecified