Provider Demographics
NPI:1548339690
Name:TIMKO, MICHELLE V (OD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:V
Last Name:TIMKO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 FAIRFIELD LN
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-1707
Mailing Address - Country:US
Mailing Address - Phone:908-672-9417
Mailing Address - Fax:908-725-0078
Practice Address - Street 1:50 DIVISION ST STE 101
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08876-2943
Practice Address - Country:US
Practice Address - Phone:908-635-3365
Practice Address - Fax:908-210-9500
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00524800152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJU44016Medicare UPIN
NJTI138082Medicare ID - Type UnspecifiedMEDICARE NUMBER