Provider Demographics
NPI:1669465704
Name:TIMMONS, GAROLD LEWIS (OD)
Entity Type:Individual
Prefix:DR
First Name:GAROLD
Middle Name:LEWIS
Last Name:TIMMONS
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 1:2440 E 5TH ST
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-3525
Mailing Address - Country:US
Mailing Address - Phone:903-595-0500
Mailing Address - Fax:903-595-1212
Practice Address - Street 1:2440 E 5TH ST
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-3525
Practice Address - Country:US
Practice Address - Phone:903-595-0500
Practice Address - Fax:903-595-1212
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3428TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX80315QOtherBLUE CROSS BLUE SHIELD
TX80315QOtherBLUE CROSS BLUE SHIELD
TXT79119Medicare UPIN