Provider Demographics
NPI:1114995255
Name:KARG, TIMOTHY C (OD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:C
Last Name:KARG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:370 E MILLTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-1280
Mailing Address - Country:US
Mailing Address - Phone:330-345-3871
Mailing Address - Fax:330-345-2011
Practice Address - Street 1:370 E MILLTOWN RD
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-1280
Practice Address - Country:US
Practice Address - Phone:330-345-3871
Practice Address - Fax:330-345-2011
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2011-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3474T985152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0534992Medicaid
OHT47872Medicare ID - Type Unspecified
OH0534992Medicaid
0240000001Medicare NSC