MEDICARE: DR. TIM W LINCOLN O.D.

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	OPC2216	FL

General Provider Information

NPI Number	:	1538296355
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TIM W LINCOLN O.D.

Provider Business Mailing Address
First Line	:	12554 S JOHN YOUNG PKWY
Second Line	:	SUITE101
City	:	ORLANDO
State	:	FL
Zip	:	32837-4004
Country	:	US
Telephone Number	:	407-850-0050
Fax Number	:	407-850-0010

Provider Business Practice Location Address
First Line	:	12554 S JOHN YOUNG PKWY
Second Line	:	SUITE101
City	:	ORLANDO
State	:	FL
Zip	:	32837-4004
Country	:	US
Telephone Number	:	407-850-0050
Fax Number	:	407-850-0010

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	07/08/2007

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