Provider Demographics
NPI:1356177455
Name:TIMBERLINE VISION
Entity type:Organization
Organization Name:TIMBERLINE VISION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JENESSA
Authorized Official - Middle Name:
Authorized Official - Last Name:LOCK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:515-339-1836
Mailing Address - Street 1:350 NW 67TH PL
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50313-1023
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:14111 DOUGLAS PARKWAY
Practice Address - Street 2:
Practice Address - City:URBANDALE
Practice Address - State:IA
Practice Address - Zip Code:50323
Practice Address - Country:US
Practice Address - Phone:515-339-1836
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-13
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty