MEDICARE: TOTAL VISION DELAND LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1285315093
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL VISION DELAND LLC

Provider Business Mailing Address
First Line	:	121 VICTORIA COMMONS BLVD STE 101
Second Line	:
City	:	DELAND
State	:	FL
Zip	:	32724-7773
Country	:	US
Telephone Number	:	386-271-0991
Fax Number	:	386-469-9272

Provider Business Practice Location Address
First Line	:	121 VICTORIA COMMONS BLVD STE 101
Second Line	:
City	:	DELAND
State	:	FL
Zip	:	32724-7773
Country	:	US
Telephone Number	:	386-271-0991
Fax Number	:	386-469-9272

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JEFFREY RYAN TIMKO
Credential	:	OD
Telephone Number	:	386-748-2571

Provider Enumeration Date	:	07/26/2023
Last Update Date	:	02/06/2024

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Directions to “TOTAL VISION DELAND LLC ” Practice Location

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