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General NPI Number Information
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NPI Number | 1932612702
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Entity Type | Organization
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Legal Business Name | MICHELLE TIMENOVICH O.D., A PROFESSIONAL OPTOMETRY CORP.
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Dates
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Enumeration Date | 11/14/2017
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Last Update Date | 10/02/2025
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Provider Practice Location Address
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Address Line | 180 NIBLICK RD
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City | PASO ROBLES
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State | CA
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Zip | 93446-4842
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Country | US
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Telephone | 805-237-0275
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Fax |
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Provider Business Mailing Address
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Address Line | 9367 RIBERENA CIR
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City | ATASCADERO
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State | CA
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Zip | 93422-6252
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST/OWNER
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Name | DR. MICHELINA LILLIAN TIMENOVICH
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Credential | OD
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Telephone | 805-238-2540
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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 | 14961TLG
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License Number State | CA
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