Provider Demographics
NPI:1912005984
Name:NIXON, TIMOTHY JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JOSEPH
Last Name:NIXON
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:PO BOX 664
Mailing Address - Street 2:
Mailing Address - City:STANWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98292
Mailing Address - Country:US
Mailing Address - Phone:360-629-9535
Mailing Address - Fax:360-629-9536
Practice Address - Street 1:27101 PIONEER HWY
Practice Address - Street 2:
Practice Address - City:STANWOOD
Practice Address - State:WA
Practice Address - Zip Code:98292
Practice Address - Country:US
Practice Address - Phone:360-629-9535
Practice Address - Fax:360-629-9536
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1505TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA410007658OtherMEDICARE RR
WA2022689Medicaid
WA2022689Medicaid
WA410007658OtherMEDICARE RR
WA0836000001Medicare NSC