Provider Demographics
NPI:1467451070
Name:BILLIG, TIMOTHY GERALD (OPTICIAN)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:GERALD
Last Name:BILLIG
Suffix:
Gender:M
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 9TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAINT CLOUD
Mailing Address - State:MN
Mailing Address - Zip Code:56303-4626
Mailing Address - Country:US
Mailing Address - Phone:320-253-9920
Mailing Address - Fax:
Practice Address - Street 1:20 9TH AVE N
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:MN
Practice Address - Zip Code:56303-4626
Practice Address - Country:US
Practice Address - Phone:320-253-9920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-15
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
54111BIOtherBCBS
0303510001Medicare ID - Type Unspecified
MN0303510001Medicare NSC