Provider Demographics
NPI:1508939182
Name:PINKE, TIM A (OD)
Entity Type:Individual
Prefix:DR
First Name:TIM
Middle Name:A
Last Name:PINKE
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:PO BOX 110
Mailing Address - Street 2:517 1ST AVE. S.
Mailing Address - City:ST. JAMES
Mailing Address - State:MN
Mailing Address - Zip Code:56081
Mailing Address - Country:US
Mailing Address - Phone:507-375-3737
Mailing Address - Fax:507-375-3610
Practice Address - Street 1:302 1ST AVE S
Practice Address - Street 2:
Practice Address - City:SAINT JAMES
Practice Address - State:MN
Practice Address - Zip Code:56081-1724
Practice Address - Country:US
Practice Address - Phone:507-375-3737
Practice Address - Fax:507-375-3715
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2375152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN462225100Medicaid
MNU27527Medicare UPIN
MN462225100Medicaid