Provider Demographics
NPI:1952411365
Name:OLINGER, TIMOTHY PAUL (OD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:PAUL
Last Name:OLINGER
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 1:15725 HAWTHORNE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAWNDALE
Mailing Address - State:CA
Mailing Address - Zip Code:90260-2651
Mailing Address - Country:US
Mailing Address - Phone:310-675-3939
Mailing Address - Fax:310-675-3628
Practice Address - Street 1:15725 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:LAWNDALE
Practice Address - State:CA
Practice Address - Zip Code:90260-2651
Practice Address - Country:US
Practice Address - Phone:310-675-3939
Practice Address - Fax:310-675-3628
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8825T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8825TOtherSTATE LICENSE
CASD0088250Medicaid
CASD0088250Medicaid
CAMO 0678461OtherDEA #
CASD0088250Medicaid