Provider Demographics
NPI:1427256536
Name:COURTNEY, TIMOTHY MICHAEL (OD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:MICHAEL
Last Name:COURTNEY
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 1:221 N 2ND AVE
Mailing Address - Street 2:PO BOX 70
Mailing Address - City:WASHINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52353-2203
Mailing Address - Country:US
Mailing Address - Phone:319-653-4558
Mailing Address - Fax:319-653-2574
Practice Address - Street 1:221 N 2ND AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IA
Practice Address - Zip Code:52353-2203
Practice Address - Country:US
Practice Address - Phone:319-653-4558
Practice Address - Fax:319-653-2574
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2008-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA002403152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA70380OtherBLUE CROSS
IAI20911Medicare PIN