Provider Demographics
NPI:1952472433
Name:SMICKER, TIMOTHY J (OD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:J
Last Name:SMICKER
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 1:125 SEATON CREST DR
Mailing Address - Street 2:
Mailing Address - City:MARS
Mailing Address - State:PA
Mailing Address - Zip Code:16046-3063
Mailing Address - Country:US
Mailing Address - Phone:724-504-2054
Mailing Address - Fax:724-504-2054
Practice Address - Street 1:400 BUTLER CMNS
Practice Address - Street 2:
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-2496
Practice Address - Country:US
Practice Address - Phone:724-282-4054
Practice Address - Fax:724-282-5645
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2014-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOET008773152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAOETOO8773OtherSTATE
PA001601865Medicaid
PASM114492Medicare PIN
PA001601865Medicaid
PAU35056Medicare UPIN