Individual provider Active NPI

Jeffrey L Timko, OD

  • Optometrist
  • Deland, FL
National Provider Identifier
1013901073
Registry record updated Sep 8, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
OPC001119 Issued in FL
Practice address
840 N Stone St
Deland, FL 32720-3256
Phone
(386) 734-1766
Fax
(386) 740-7866
NPI assigned
Sep 7, 2005
Last updated
Sep 8, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 8, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPC001119 FL Primary

Addresses

Primary practice location

840 N Stone St
Deland, FL 32720-3256

Mailing address

1950 Old Gallows Rd Ste 520
Vienna, VA 22182-3970
Phone (703) 847-8899

Other identifiers 1

IdentifierTypeStateIssuer
084690200MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100525000196 FL Practitioner - Optometry 3173590494 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Ohio State University - College of Optometry, 1973
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Myeyedr Optometry of Florida, LLCGroup PAC ID 0143541037, 141 clinicians

Practice addresses (Care Compare)

840 N Stone St
Deland, FL 32720-3256
Phone (386) 734-1766

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1119FLMDEndodontist
OPC001119FLMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Myeyedr Optometry of Florida, LLC Optometrist Current Accepting new patients
Myeyedr Optometry of Florida, LLC Optometrist CurrentSince Sep 27, 2021 Accepting new patients
Myeyedr Optometry of Florida, LLC Optometrist CurrentSince Sep 27, 2021 Accepting new patients
Timko and Cady OD PA Optometrist PastSince Jan 15, 2011 Accepting new patients

Locations

3011 W Yamato Rd
Ste A19
Boca Raton, FL 33434
Phone (561) 995-9600

840 N Stone St
Deland, FL 32720
Phone (386) 734-1766

15 Cypress Branch Way
Ste 205
Palm Coast, FL 32164
Phone (386) 445-1880

1480 Timberlane Rd
Tallahassee, FL 32312
Phone (850) 878-1601

1950 Old Gallows Rd
Ste 520
Vienna, VA 22182

8614 Westwood Center Dr
Fl 9
Vienna, VA 22182

Networks

  • FL HMO
  • FL PPO
  • Freedom Health HMO Network

Organizations & group practices 5

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126051200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631059200000",
    "number": "1013901073",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 OLD GALLOWS RD STE 520",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221823970",
            "telephone_number": "703-847-8899",
            "fax_number": "571-223-6780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "840 N STONE ST",
            "city": "DELAND",
            "state": "FL",
            "postal_code": "327203256",
            "telephone_number": "386-734-1766",
            "fax_number": "386-740-7866"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TIMKO",
        "first_name": "JEFFREY",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-07",
        "last_updated": "2021-09-08",
        "certification_date": "2021-09-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC001119",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "084690200",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Deland, FL

Sources for this page

Verify at the official NPI Registry.