1225052301 NPI number — TYLER RIDGE VISION CARE, LTD.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225052301 NPI number — TYLER RIDGE VISION CARE, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TYLER RIDGE VISION CARE, LTD.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225052301
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 E. MAIN ST.
Provider Second Line Business Mailing Address:
#C
Provider Business Mailing Address City Name:
SAINT CHARLES
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60174
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-584-1111
Provider Business Mailing Address Fax Number:
630-584-1239

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 E MAIN ST
Provider Second Line Business Practice Location Address:
#C
Provider Business Practice Location Address City Name:
SAINT CHARLES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60174-2202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-584-1111
Provider Business Practice Location Address Fax Number:
630-584-1239
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
YUVAN
Authorized Official First Name:
DOUGLAS
Authorized Official Middle Name:
AARON
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
630-584-1111

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  46-008116 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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