Provider Demographics
NPI:1619961422
Name:ARBOW, TIMOTHY J (OD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:ARBOW
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 1:690 E 18TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-4360
Mailing Address - Country:US
Mailing Address - Phone:541-485-2020
Mailing Address - Fax:541-342-2436
Practice Address - Street 1:690 E 18TH AVE
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-4360
Practice Address - Country:US
Practice Address - Phone:541-485-2020
Practice Address - Fax:541-342-2436
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-07
Last Update Date:2009-05-21
Deactivation Date:2006-03-25
Deactivation Code:
Reactivation Date:2006-04-05
Provider Licenses
StateLicense IDTaxonomies
OR1300ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR144147Medicaid
ORR0000PGCZZMedicare PIN
OR144147Medicaid
OR0256600001Medicare NSC