Individual
TIMOTHY L TELLO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1221 W DIVIDE AVE, SUITE 1, BISMARCK, ND 58501-1290
(701) 224-0661
(701) 224-0663
Mailing address
1221 W DIVIDE AVE, SUITE 1, BISMARCK, ND 58501-1290
(701) 224-0661
(701) 224-0663
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
477
ND
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
60409
—
ND
Enumeration date
09/20/2006
Last updated
07/08/2007
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