Healthcare Provider Details

I. General information

NPI: 1982749057
Provider Name (Legal Business Name): TIMOTHY WILLIAM TANDROW O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 MONTGOMERY ST
SAN FRANCISCO CA
94104-2901
US

IV. Provider business mailing address

34 SANDERS RANCH RD
MORAGA CA
94556-2805
US

V. Phone/Fax

Practice location:
  • Phone: 415-397-0380
  • Fax: 415-397-0395
Mailing address:
  • Phone: 925-376-7698
  • Fax: 925-376-6268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number5786T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: