Provider Demographics
NPI:1265586739
Name:JEFFREY L TIMKO OD PA
Entity type:Organization
Organization Name:JEFFREY L TIMKO OD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:TIMKO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:386-734-1766
Mailing Address - Street 1:840 N STONE ST
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-3256
Mailing Address - Country:US
Mailing Address - Phone:386-734-1766
Mailing Address - Fax:386-740-7866
Practice Address - Street 1:840 N STONE ST
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-3256
Practice Address - Country:US
Practice Address - Phone:386-734-1766
Practice Address - Fax:386-740-7866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2010-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2236152W00000X
FLOPC1119152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL079146600Medicaid
FL079146600Medicaid
FL0757110001Medicare NSC
FL39672Medicare PIN