Provider Demographics
NPI:1639191620
Name:OMLEY, TIMOTHY HERBERT (DO)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:HERBERT
Last Name:OMLEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3916 STATE ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-5602
Mailing Address - Country:US
Mailing Address - Phone:805-563-3010
Mailing Address - Fax:
Practice Address - Street 1:615 FULTON ST
Practice Address - Street 2:
Practice Address - City:PORT CLINTON
Practice Address - State:OH
Practice Address - Zip Code:43452-2001
Practice Address - Country:US
Practice Address - Phone:419-734-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3936207P00000X
OH34.003481207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
A15479Medicare UPIN