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General NPI Number Information
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NPI Number | 1629074067
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Entity Type | Individual
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Provider Name | TIMOTHY E. UNDERHILL O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/21/2005
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Last Update Date | 03/16/2015
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Provider Practice Location Address
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Address Line | 5995 S POINTE BLVD STE 111
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City | FORT MYERS
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State | FL
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Zip | 33919-3273
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Country | US
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Telephone | 239-482-0355
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Fax | 239-482-8930
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Provider Business Mailing Address
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Address Line | 5995 S POINTE BLVD STE 111
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City | FORT MYERS
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State | FL
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Zip | 33919-3273
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Country | US
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Telephone | 239-482-0355
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Fax | 239-482-8930
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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 | OPC001788
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License Number State | FL
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