Basic Information
| Provider Information | |||||||||
| NPI: | 1730193293 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SCRANTON | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | ALLEN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | OD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6220 OLD DOBBIN LN | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210455812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102846700 | ||||||||
| FaxNumber: | 6123670841 | ||||||||
| Practice Location | |||||||||
| Address1: | 1409 MERRITT BLVD STE B | ||||||||
| Address2: | |||||||||
| City: | DUNDALK | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212222142 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4102846700 | ||||||||
| FaxNumber: | 6123670841 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 05/12/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OP1000211 | DC | Y | Eye and Vision Services Providers | Optometrist | 152W00000X | 0618001975 | VA | N | Eye and Vision Services Providers | Optometrist | 152W00000X | TA1361 | MD | N | Eye and Vision Services Providers | Optometrist |
No ID Information.