Provider Demographics
NPI:1629065149
Name:EARLEY, TIMOTHY W (OD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:W
Last Name:EARLEY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21550-5112
Mailing Address - Country:US
Mailing Address - Phone:301-334-1146
Mailing Address - Fax:301-334-9729
Practice Address - Street 1:888 MEMORIAL DR STE 201
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:MD
Practice Address - Zip Code:21550-5112
Practice Address - Country:US
Practice Address - Phone:301-334-1146
Practice Address - Fax:301-334-9729
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH4924/T1794152W00000X, 152WC0802X, 152WP0200X, 152WV0400X
MDTA2997152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH5408550OtherFIRST HEALTH
OH5086030OtherCIGNA
OH000000230621OtherANTHEM BLUE CROSS/BLUE SH
OH0488300001OtherADMINISTAR FEDERAL
OH341704134TEOtherSUMMA CARE
OH410040999OtherMEDICARE RAILROAD
OH0863201Medicare PIN
OH5086030OtherCIGNA