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General NPI Number Information
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NPI Number | 1508939182
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Entity Type | Individual
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Provider Name | TIM A PINKE O.D.
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Gender | Male
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Dates
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Enumeration Date | 11/15/2006
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Last Update Date | 03/10/2016
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Provider Practice Location Address
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Address Line | 302 1ST AVE S
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City | SAINT JAMES
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State | MN
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Zip | 56081-1724
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Country | US
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Telephone | 507-375-3737
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Fax | 507-375-3715
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Provider Business Mailing Address
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Address Line | PO BOX 110 517 1ST AVE. S.
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City | ST. JAMES
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State | MN
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Zip | 56081
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Country | US
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Telephone | 507-375-3737
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Fax | 507-375-3610
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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 | 2375
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License Number State | MN
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