Provider Demographics
NPI:1629042965
Name:TIEU, TIMOTHY G (OD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:G
Last Name:TIEU
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 1:97 RAILROAD AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-3852
Mailing Address - Country:US
Mailing Address - Phone:925-820-2064
Mailing Address - Fax:925-820-2162
Practice Address - Street 1:97 RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-3852
Practice Address - Country:US
Practice Address - Phone:925-820-2064
Practice Address - Fax:925-820-2162
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11757T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU86658Medicare UPIN
CABX302AMedicare PIN