Active NPI
Timothy Jon Guthrie, O.D
- Optometrist
- Southgate, MI
National Provider Identifier
1437181039
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 4901003818
- Practice address
- 18900 Eureka Rd
Southgate, MI 48195-2985 - Phone
- (734) 324-0996
- Fax
- (734) 284-9335
- NPI assigned
- Jul 6, 2006
- Last updated
- Mar 11, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4901003818 | MI | Primary |
Addresses
Primary practice location
18900 Eureka Rd
Southgate, MI 48195-2985
Mailing address
655 W.13 Mile Road
Madison HGTS, MI 48071
Phone (248) 577-3659
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4901003818 | MI | MD | Optometrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152144000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1394496000000",
"number": "1437181039",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "655 W.13 MILE ROAD",
"city": "MADISON HGTS",
"state": "MI",
"postal_code": "48071",
"telephone_number": "248-577-3659",
"fax_number": "248-588-9320"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "18900 EUREKA RD",
"city": "SOUTHGATE",
"state": "MI",
"postal_code": "481952985",
"telephone_number": "734-324-0996",
"fax_number": "734-284-9335"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GUTHRIE",
"first_name": "TIMOTHY",
"middle_name": "JON",
"name_prefix": "Dr.",
"credential": "O.D",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-06",
"last_updated": "2014-03-11",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MI",
"license": "4901003818",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Southgate, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.