Individual
DR. TIMOTHY CHARLES NEITZKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
340 FOX ST, PERHAM, MN 56573
(218) 346-3310
(218) 346-9064
Mailing address
38004 N LITTLE MCDONALD DR, FRAZEE, MN 56544-8931
(218) 346-5443
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2262
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
869723000
—
MN
Enumeration date
07/27/2006
Last updated
07/14/2010
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