MEDICARE: MICHELLE V TIMKO 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	152WC0802X	Corneal and Contact Management Optometrist	27OA00524800	NJ
2	152W00000X	Optometrist	27OA00524800	NJ

General Provider Information

NPI Number	:	1548339690
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHELLE V TIMKO O.D.

Provider Business Mailing Address
First Line	:	192 FAIRFIELD LN
Second Line	:
City	:	HILLSBOROUGH
State	:	NJ
Zip	:	08844-1707
Country	:	US
Telephone Number	:	908-672-9417
Fax Number	:	908-725-0078

Provider Business Practice Location Address
First Line	:	50 DIVISION ST STE 101
Second Line	:
City	:	SOMERVILLE
State	:	NJ
Zip	:	08876-2943
Country	:	US
Telephone Number	:	908-635-3365
Fax Number	:	908-210-9500

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	11/13/2019

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