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General NPI Number Information
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NPI Number | 1255365300
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Entity Type | Individual
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Provider Name | TIMOTHY WAYNE ROBERTSON O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/11/2006
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Last Update Date | 12/07/2021
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Provider Practice Location Address
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Address Line | 400 SOLANO ST
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City | CORNING
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State | CA
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Zip | 96021-3433
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Country | US
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Telephone | 530-824-2166
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Fax | 530-824-5916
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Provider Business Mailing Address
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Address Line | 114 MISSION RANCH BLVD STE 50
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City | CHICO
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State | CA
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Zip | 95926-5137
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Country | US
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Telephone | 530-924-0749
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Fax | 530-895-1664
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OP9551
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License Number State | CA
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