Provider Demographics
NPI:1063825156
Name:NG, TIMOTHY (OD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:NG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 E MARCH LN # 0
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95210-4500
Mailing Address - Country:US
Mailing Address - Phone:209-957-8000
Mailing Address - Fax:209-957-8077
Practice Address - Street 1:1101 E MARCH LN # 0
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95210-4500
Practice Address - Country:US
Practice Address - Phone:209-957-8000
Practice Address - Fax:209-957-8077
Is Sole Proprietor?:No
Enumeration Date:2014-06-05
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14912152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist