Provider Demographics
NPI:1588860571
Name:TIMOTHY L. OSIUS JR. O.D. INC.
Entity type:Organization
Organization Name:TIMOTHY L. OSIUS JR. O.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:OSIUS
Authorized Official - Suffix:JR
Authorized Official - Credentials:OD
Authorized Official - Phone:970-669-8555
Mailing Address - Street 1:2980 GINNALA DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-2701
Mailing Address - Country:US
Mailing Address - Phone:970-669-8555
Mailing Address - Fax:970-669-8556
Practice Address - Street 1:2980 GINNALA DR.
Practice Address - Street 2:SUITE A
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-2701
Practice Address - Country:US
Practice Address - Phone:970-669-8555
Practice Address - Fax:970-669-8556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCO-OPT-1610152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COCO-OPT-1610OtherCOLORADO OPTEMETRIC LIC
COCO-OPT-1610OtherCOLORADO OPTEMETRIC LIC
COU46824Medicare UPIN
CO5387740001Medicare NSC
COC801300Medicare PIN