Provider Demographics
NPI:1306929641
Name:MILBURN, TIMOTHY MICHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:MICHAEL
Last Name:MILBURN
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 1:4160 W SPRING CREEK PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75024-5317
Mailing Address - Country:US
Mailing Address - Phone:330-416-4569
Mailing Address - Fax:
Practice Address - Street 1:4160 W SPRING CREEK PKWY STE 100
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75024-5317
Practice Address - Country:US
Practice Address - Phone:330-725-4680
Practice Address - Fax:330-725-2010
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5133152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2195833Medicaid
OHU80927Medicare UPIN
OHMI-4027383Medicare ID - Type Unspecified