Provider Demographics
NPI:1275073371
Name:TIMOTHY W. ROBERTSON, O.D., PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:TIMOTHY W. ROBERTSON, O.D., PROFESSIONAL CORPORATION
Other - Org Name:CORNING EYECARE CENTER OF OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:W
Authorized Official - Last Name:ROBERTSON
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:530-934-3373
Mailing Address - Street 1:400 SOLANO ST
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:CA
Mailing Address - Zip Code:96021-3433
Mailing Address - Country:US
Mailing Address - Phone:530-824-2166
Mailing Address - Fax:530-824-5916
Practice Address - Street 1:400 SOLANO ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:CA
Practice Address - Zip Code:96021-3433
Practice Address - Country:US
Practice Address - Phone:530-824-2166
Practice Address - Fax:530-824-5916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-08
Last Update Date:2017-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty