Provider Demographics
NPI:1902473457
Name:KVINTA, TYLER AUSTIN (OD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:AUSTIN
Last Name:KVINTA
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 1:5312 JOHN STOCKBAUER DR APT 1012
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77904-1274
Mailing Address - Country:US
Mailing Address - Phone:361-208-5756
Mailing Address - Fax:
Practice Address - Street 1:6380 N NAVARRO ST
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-1721
Practice Address - Country:US
Practice Address - Phone:361-570-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-04
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX10320152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program