Provider Demographics
NPI:1780741959
Name:ANDERSON, TIMOTHY PHILIP (OD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:PHILIP
Last Name:ANDERSON
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 1:69 N WINTERGARDEN RD
Mailing Address - Street 2:
Mailing Address - City:FLETCHER
Mailing Address - State:NC
Mailing Address - Zip Code:28732-8211
Mailing Address - Country:US
Mailing Address - Phone:828-681-8312
Mailing Address - Fax:828-693-5558
Practice Address - Street 1:3450 ASHEVILLE HWY
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28791-0701
Practice Address - Country:US
Practice Address - Phone:828-692-2593
Practice Address - Fax:828-693-5558
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1484152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0968AOtherBCBS OF NC
NC890968AMedicaid
NCP00041341OtherRAILROAD MEDICARE
NC2280036OtherUNITED HEALTHCARE OF NC
NC2469207EMedicare ID - Type Unspecified
NC2280036OtherUNITED HEALTHCARE OF NC