MEDICARE: DR. JEFFREY RYAN TIMKO OD

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	OPC4195	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	36033	OTHER	FL	BCBS
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982743597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY RYAN TIMKO OD

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	02/06/2024

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