Provider Demographics
NPI:1912031857
Name:BOBBITT, TIMOTHY D (OD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:D
Last Name:BOBBITT
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 1:398 STONE BROOK DR
Mailing Address - Street 2:
Mailing Address - City:GALAX
Mailing Address - State:VA
Mailing Address - Zip Code:24333-6235
Mailing Address - Country:US
Mailing Address - Phone:276-238-9977
Mailing Address - Fax:276-238-9977
Practice Address - Street 1:2851 CARROLLTON PIKE
Practice Address - Street 2:A2
Practice Address - City:WOODLAWN
Practice Address - State:VA
Practice Address - Zip Code:24381-3637
Practice Address - Country:US
Practice Address - Phone:276-238-9977
Practice Address - Fax:276-238-9977
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000653152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAU78498Medicare UPIN