Individual
DR. TIMOTHY CHARLES WISE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODT1181
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
35966431
—
TN
01
—
4148974
BLUE CROSS BLUE SHIELD TN
TN
Enumeration date
07/24/2006
Last updated
01/09/2008
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