Provider Demographics
NPI:1912912718
Name:JANKOWSKI, TIMOTHY CHARLES (OD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:CHARLES
Last Name:JANKOWSKI
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 1:16450 BOLSA CHICA STREET
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-2603
Mailing Address - Country:US
Mailing Address - Phone:714-840-1366
Mailing Address - Fax:714-846-9415
Practice Address - Street 1:16450 BOLSA CHICA ST
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92649-2603
Practice Address - Country:US
Practice Address - Phone:714-840-1366
Practice Address - Fax:714-846-9415
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6966T152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMJ1359567OtherDEA NUMBER
CAMJ1359567OtherDEA NUMBER
CAT70161Medicare UPIN
CAWOP6966AMedicare PIN