Individual
DR. TIMOTHY GLENN MOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
100382
ID
152W00000X
Optometrist
60677430
WA
152W00000X
Optometrist
Primary
OD60677430
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2237369
—
WA
Enumeration date
09/24/2016
Last updated
01/03/2024
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