Provider Demographics
NPI:1669476255
Name:KHATER, TIMOTHY TAMIM (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:TAMIM
Last Name:KHATER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5109 80TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-3017
Mailing Address - Country:US
Mailing Address - Phone:806-792-5900
Mailing Address - Fax:806-792-6092
Practice Address - Street 1:5109 80TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424
Practice Address - Country:US
Practice Address - Phone:806-792-5900
Practice Address - Fax:806-792-6092
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2019-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK3276207W00000X, 207WX0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092254403Medicaid
180036465OtherRAILROAD MEDICARE
TXG68622Medicare UPIN
8D4032Medicare PIN
180036465OtherRAILROAD MEDICARE
180036465Medicare Oscar/Certification