Provider Demographics
NPI:1851472740
Name:KIME, TIMOTHY Q (OD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:Q
Last Name:KIME
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 1:4021 W SYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4428
Mailing Address - Country:US
Mailing Address - Phone:419-475-6181
Mailing Address - Fax:419-475-5720
Practice Address - Street 1:4021 W SYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4428
Practice Address - Country:US
Practice Address - Phone:419-475-6181
Practice Address - Fax:419-475-5720
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2690 T513152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHD09328471Medicare ID - Type UnspecifiedMEDICARE
OHT46083Medicare UPIN