Provider Demographics
NPI:1942244835
Name:SAJBAN, TIMOTHY JON (OD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JON
Last Name:SAJBAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:619 WAKEBY RD
Mailing Address - Street 2:ADVANCED EYECARE SPECIALISTS, P.C.
Mailing Address - City:MARSTONS MILLS
Mailing Address - State:MA
Mailing Address - Zip Code:02648-1623
Mailing Address - Country:US
Mailing Address - Phone:508-280-2479
Mailing Address - Fax:508-428-1118
Practice Address - Street 1:352 MAIN ST
Practice Address - Street 2:ADVANCED EYECARE SPECIALISTS, P.C.
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-3175
Practice Address - Country:US
Practice Address - Phone:508-444-8691
Practice Address - Fax:508-444-8693
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA3456152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0371751Medicaid
T88024Medicare UPIN
MA423858Medicare ID - Type Unspecified