Individual
TIMOTHY H ISTOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
MEDICAL CENTER BLVD, WINSTON SALEM, NC 27157-0001
(336) 716-2255
(336) 716-7994
Mailing address
PO BOX 344, WINSTON SALEM, NC 27102-0344
(336) 716-2255
(336) 716-7994
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1311
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
093T7
BCBS
NC
05
—
10157765
—
VA
05
—
3810002311
—
WV
05
—
5900639
—
NC
01
—
806736
PARTNERS
NC
01
—
E2101
MEDCOST
NC
Enumeration date
11/28/2005
Last updated
08/20/2010
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