Provider Demographics
NPI:1750542825
Name:THIMESCH, RENEE LYNN (OD)
Entity type:Individual
Prefix:DR
First Name:RENEE
Middle Name:LYNN
Last Name:THIMESCH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:RENEE
Other - Middle Name:LYNN
Other - Last Name:TJEERDSMA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2677 E DANIEL DR
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-0571
Mailing Address - Country:US
Mailing Address - Phone:503-312-6714
Mailing Address - Fax:
Practice Address - Street 1:21300 N JOHN WAYNE PKWY STE 105
Practice Address - Street 2:
Practice Address - City:MARICOPA
Practice Address - State:AZ
Practice Address - Zip Code:85139-8964
Practice Address - Country:US
Practice Address - Phone:520-201-3937
Practice Address - Fax:520-201-3939
Is Sole Proprietor?:No
Enumeration Date:2008-06-22
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3142152W00000X
AZ2004152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist