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General NPI Number Information
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NPI Number | 1982743597
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Entity Type | Individual
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Provider Name | JEFFREY RYAN TIMKO OD
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Gender | Male
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Dates
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Enumeration Date | 02/06/2007
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Last Update Date | 02/06/2024
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Provider Practice Location Address
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Address Line | 121 VICTORIA COMMONS BLVD STE 101
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City | DELAND
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State | FL
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Zip | 32724-7773
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Country | US
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Telephone | 386-271-0991
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Fax | 386-469-9272
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Provider Business Mailing Address
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Address Line | 121 VICTORIA COMMONS BLVD STE 101
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City | DELAND
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State | FL
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Zip | 32724-7773
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Country | US
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Telephone | 386-271-0991
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Fax | 386-469-9272
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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 | OPC4195
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License Number State | FL
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