Provider Demographics
NPI:1437181039
Name:GUTHRIE, TIMOTHY JON (OD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JON
Last Name:GUTHRIE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:655 W.13 MILE ROAD
Mailing Address - Street 2:
Mailing Address - City:MADISON HGTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071
Mailing Address - Country:US
Mailing Address - Phone:248-577-3659
Mailing Address - Fax:248-588-9320
Practice Address - Street 1:18900 EUREKA RD
Practice Address - Street 2:
Practice Address - City:SOUTHGATE
Practice Address - State:MI
Practice Address - Zip Code:48195-2985
Practice Address - Country:US
Practice Address - Phone:734-324-0996
Practice Address - Fax:734-284-9335
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2014-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901003818152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU63440Medicare UPIN