Provider Demographics
NPI:1700072360
Name:PERRY, TIMOTHY JAY (OD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JAY
Last Name:PERRY
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 1:3856 STRATFORD CIR
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31605-4855
Mailing Address - Country:US
Mailing Address - Phone:229-245-7227
Mailing Address - Fax:229-244-5287
Practice Address - Street 1:120 BENJAMIN H HILL DR W
Practice Address - Street 2:
Practice Address - City:FITZGERALD
Practice Address - State:GA
Practice Address - Zip Code:31750-8607
Practice Address - Country:US
Practice Address - Phone:229-563-7870
Practice Address - Fax:229-244-5287
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT001635152W00000X
VT030/0000165152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU68330Medicare UPIN
GA41ZCDGDMedicare PIN