Provider Demographics
NPI:1861615254
Name:TYLER EYE CARE, P.A.
Entity type:Organization
Organization Name:TYLER EYE CARE, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER AND OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:NESHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUDD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:903-534-8349
Mailing Address - Street 1:4139 S BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-8720
Mailing Address - Country:US
Mailing Address - Phone:903-534-8349
Mailing Address - Fax:903-581-8203
Practice Address - Street 1:4139 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-8720
Practice Address - Country:US
Practice Address - Phone:903-534-8349
Practice Address - Fax:903-581-8203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-11
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00371WMedicare PIN