Individual
DR. TIMOTHY MICHAEL SULT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
6120 GLENWOOD AVE, SUITE 104, RALEIGH, NC 27612-2614
(919) 571-1366
(919) 571-7146
Mailing address
12828 LINDLEY DR, RALEIGH, NC 27614-8776
(919) 841-0404
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1309
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
09885
BLUE CROSS BLUE SHIELD
NC
01
—
2256770
UNITED HEALTH CARE
NC
05
—
8909885
—
NC
Enumeration date
04/23/2007
Last updated
09/12/2007
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