Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | MD00018767 | WA |
N | 207W00000X | Ophthalmologist | MD10713 | OR |
NPI | 1033190558 |
---|---|
Provider Name | Dr. Timothy Francis Vrtiska |
First Address | Longview, WA 98632-4667 |
Second Address | Longview, WA 98632-4667 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/11/2005 |
Last Update Date | 14/10/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1723402 | (05) | WA |
180011766 | RAILROAD MEDICARE (01) | WA |
A16716 | (02) |