Provider Demographics
NPI:1730742057
Name:THATCHER, TIM
Entity type:Individual
Prefix:
First Name:TIM
Middle Name:
Last Name:THATCHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 NW 9TH ST STE 107
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73102-2619
Mailing Address - Country:US
Mailing Address - Phone:405-595-3226
Mailing Address - Fax:
Practice Address - Street 1:229 NW 9TH ST STE 107
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73102-2619
Practice Address - Country:US
Practice Address - Phone:405-595-3226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist