Provider Demographics
NPI:1730193293
Name:SCRANTON, TIMOTHY ALLEN (OD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:ALLEN
Last Name:SCRANTON
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 1:6220 OLD DOBBIN LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-5812
Mailing Address - Country:US
Mailing Address - Phone:410-284-6700
Mailing Address - Fax:612-367-0841
Practice Address - Street 1:1409 MERRITT BLVD STE B
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-2142
Practice Address - Country:US
Practice Address - Phone:410-284-6700
Practice Address - Fax:612-367-0841
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCOP1000211152W00000X
VA0618001975152W00000X
MDTA1361152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist