Healthcare Provider Details

I. General information

NPI: 1114234432
Provider Name (Legal Business Name): JOHN MCDONALD OD & TIM ROBERTSON OD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 10/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 N VILLA AVE
WILLOWS CA
95988-2607
US

IV. Provider business mailing address

245 N VILLA AVE
WILLOWS CA
95988-2607
US

V. Phone/Fax

Practice location:
  • Phone: 530-934-3373
  • Fax: 530-934-3522
Mailing address:
  • Phone: 530-934-3373
  • Fax: 530-934-3522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT9551 T
License Number StateCA

VIII. Authorized Official

Name: TIMOTHY ROBERTSON
Title or Position: OPTOMETRIST, OWNER
Credential: O.D.
Phone: 530-934-3373