Provider Demographics
NPI:1255365300
Name:ROBERTSON, TIMOTHY WAYNE (OD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:WAYNE
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:114 MISSION RANCH BLVD
Mailing Address - Street 2:STE 50
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-5137
Mailing Address - Country:US
Mailing Address - Phone:530-924-0749
Mailing Address - Fax:530-895-1664
Practice Address - Street 1:400 SOLANO ST
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:CA
Practice Address - Zip Code:96021-3433
Practice Address - Country:US
Practice Address - Phone:530-824-2166
Practice Address - Fax:530-824-5916
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2021-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAOP9551152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist