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General NPI Number Information
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NPI Number | 1114234432
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Entity Type | Organization
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Legal Business Name | JOHN MCDONALD OD & TIM ROBERTSON OD
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Dates
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Enumeration Date | 09/08/2010
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Last Update Date | 10/19/2010
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Provider Practice Location Address
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Address Line | 245 N VILLA AVE
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City | WILLOWS
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State | CA
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Zip | 95988-2607
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Country | US
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Telephone | 530-934-3373
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Fax | 530-934-3522
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Provider Business Mailing Address
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Address Line | 245 N VILLA AVE
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City | WILLOWS
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State | CA
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Zip | 95988-2607
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Country | US
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Telephone | 530-934-3373
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Fax | 530-934-3522
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Authorized Official
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Title or Position | OPTOMETRIST, OWNER
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Name | TIMOTHY ROBERTSON
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Credential | O.D.
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Telephone | 530-934-3373
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPT9551 T
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License Number State | CA
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