Individual
TIMOTHY M WESTGATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O. D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
130001190
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000214822
—
DE
01
—
000A74H16
MEDICARE PTAN
—
01
—
11220847
CAQH
—
01
—
1245251313
MEDICARE GROUP NPI
—
01
—
G00016
MEDICARE GROUP PIN
—
01
—
I3-0001190
LICENSE
DE
Enumeration date
02/17/2006
Last updated
02/27/2018
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