Organization Active NPI

Timothy R. Corl OD, PC

  • Optometrist
  • Palmyra, PA
National Provider Identifier
1659604478
Registry record updated Sep 11, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OEG001986 Issued in PA
Legal business name
TIMOTHY R. CORL OD, PC
Practice address
100 N Londonderry SQ
Palmyra, PA 17078-3904
Phone
(717) 838-9484
Fax
(717) 838-9582
NPI assigned
Sep 11, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 11, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Timothy Ryan Corl, O.D.
Title
Optometrist
Phone
(717) 269-5346

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X OEG001986 PA Primary

Addresses

Primary practice location

100 N Londonderry SQ
Palmyra, PA 17078-3904

Mailing address

100 N Londonderry SQ
Palmyra, PA 17078-3904
Phone (717) 838-9484

Other identifiers 1

IdentifierTypeStateIssuer
1022848630001MedicaidPA

National Provider Directory

National Provider Directory

Locations

2901 Horseshoe Pike
Palmyra, PA 17078
Phone (717) 473-3802

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1252627200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1252627200000",
    "number": "1659604478",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N LONDONDERRY SQ",
            "city": "PALMYRA",
            "state": "PA",
            "postal_code": "170783904",
            "telephone_number": "717-838-9484",
            "fax_number": "717-838-9582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 N LONDONDERRY SQ",
            "city": "PALMYRA",
            "state": "PA",
            "postal_code": "170783904",
            "telephone_number": "717-838-9484",
            "fax_number": "717-838-9582"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TIMOTHY R. CORL OD, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-09-11",
        "last_updated": "2009-09-11",
        "status": "A",
        "authorized_official_last_name": "CORL",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "RYAN",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "717-269-5346",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG001986",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1022848630001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Palmyra, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.