Individual
DERRON TIMOTHY LEE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2321 W MARCH LN, STOCKTON, CA 95207-5261
(209) 986-1880
(209) 957-8077
Mailing address
2321 W MARCH LN STE A, STOCKTON, CA 95207-5265
(209) 986-1880
(209) 957-8077
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
12387T
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
11620
MESC
CA
01
—
CA2387
EYEMED
CA
Enumeration date
09/30/2006
Last updated
09/27/2024
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