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General NPI Number Information
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NPI Number | 1265846703
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Entity Type | Individual
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Provider Name | FELICIA JEAN TIMMERMANN O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/12/2014
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Last Update Date | 11/05/2018
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Provider Practice Location Address
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Address Line | 3200 S UNIVERSITY DR BLDG 2
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City | DAVIE
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State | FL
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Zip | 33328-2018
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Country | US
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Telephone | 954-262-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 660 S EUCLID AVE # 8096
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City | SAINT LOUIS
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State | MO
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Zip | 63110-1010
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Country | US
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Telephone | 314-747-5380
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Fax | 314-362-5590
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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 | OPC5452
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2017031245
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046010899
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 6326
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License Number State | OH
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