Provider Demographics
NPI:1730442997
Name:ROBINSON, TIMOTHY MADSEN (OD)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:MADSEN
Last Name:ROBINSON
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:PO BOX 614
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WY
Mailing Address - Zip Code:82701-0614
Mailing Address - Country:US
Mailing Address - Phone:605-929-7633
Mailing Address - Fax:
Practice Address - Street 1:101 S RAILWAY AVE
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:WY
Practice Address - Zip Code:82701-2814
Practice Address - Country:US
Practice Address - Phone:307-746-2371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY344T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist