Individual
TIMOTHY JOHN SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
I3-0001338
DE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1245251313
GRP NPI
DE
01
—
13-0001338
DE PROFESSIONAL LICENSE
DE
01
—
G00016
MEDICARE GROUP ID
DE
Enumeration date
08/13/2009
Last updated
09/13/2010
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