Provider Demographics
NPI:1811100761
Name:MCAULIFFE, TIMOTHY JOHN (OD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:JOHN
Last Name:MCAULIFFE
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 1:4015 EAST BELL ROAD
Mailing Address - Street 2:SUITE # 136
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-2243
Mailing Address - Country:US
Mailing Address - Phone:602-971-5858
Mailing Address - Fax:602-404-1879
Practice Address - Street 1:4015 EAST BELL ROAD
Practice Address - Street 2:SUITE # 136
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-2243
Practice Address - Country:US
Practice Address - Phone:602-971-5858
Practice Address - Fax:602-404-1879
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ636152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ86-0649146OtherVISION SERVICE PLAN TAXID
AZAZ0636OtherEYEMED PROVIDER #
AZAZ0636OtherEYEMED PROVIDER #
AZAZ0636OtherEYEMED PROVIDER #
AZOD636AMedicare UPIN
AZMM1524847OtherDEA #
AZ0446740001Medicare ID - Type UnspecifiedCIGNA #