Provider Demographics
NPI:1629074067
Name:UNDERHILL, TIMOTHY E (OD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:E
Last Name:UNDERHILL
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 1:5995 S POINTE BLVD
Mailing Address - Street 2:STE 111
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-3273
Mailing Address - Country:US
Mailing Address - Phone:239-482-0355
Mailing Address - Fax:239-482-8930
Practice Address - Street 1:5995 S POINTE BLVD
Practice Address - Street 2:STE 111
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-3273
Practice Address - Country:US
Practice Address - Phone:239-482-0355
Practice Address - Fax:239-482-8930
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC001788152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078232700Medicaid
FL078232700Medicaid
FL19230Medicare PIN