Active NPI
Timothy Dale Horner, OD
- Optometrist
- Wheelersburg, OH
National Provider Identifier
1194708511
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 3321 T1247
- Practice address
- 536 Bulwer St
Wheelersburg, OH 45694-1907 - Phone
- (740) 574-4745
- Fax
- (740) 574-5144
- NPI assigned
- Nov 21, 2005
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 3321 T1247 | OH | Primary |
Addresses
Primary practice location
536 Bulwer St
Wheelersburg, OH 45694-1907
Mailing address
536 Bulwer St
PO Box 158
Wheelersburg, OH 45694-1907
Phone (740) 574-4745
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0417749 | Medicaid | OH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3321 T1247 | OH | MD | Optometrist |
| 3321 | OH | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1132531200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1283731200000",
"number": "1194708511",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "536 BULWER ST",
"address_2": "PO BOX 158",
"city": "WHEELERSBURG",
"state": "OH",
"postal_code": "456941907",
"telephone_number": "740-574-4745",
"fax_number": "740-574-5144"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "536 BULWER ST",
"city": "WHEELERSBURG",
"state": "OH",
"postal_code": "456941907",
"telephone_number": "740-574-4745",
"fax_number": "740-574-5144"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HORNER",
"first_name": "TIMOTHY",
"middle_name": "DALE",
"name_prefix": "Dr.",
"credential": "OD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-11-21",
"last_updated": "2010-09-06",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "OH",
"license": "3321 T1247",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0417749",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wheelersburg, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.