Provider Demographics
NPI:1497824478
Name:SUORSA, TIMOTHY PAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:PAUL
Last Name:SUORSA
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 1:524 W PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3274
Mailing Address - Country:US
Mailing Address - Phone:559-784-5127
Mailing Address - Fax:559-784-4288
Practice Address - Street 1:524 W PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3274
Practice Address - Country:US
Practice Address - Phone:559-784-5127
Practice Address - Fax:559-784-4288
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10864T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5664210001OtherMEDICARE NSC
CAP00294171OtherRAILROAD MEDICARE
CAGSD004930Medicaid
CASD0108641Medicare PIN
CAGSD004930Medicaid