1285652826 NPI number — DR. ERIC RICHARD TYLER O. D.

Table of content: DR. ERIC RICHARD TYLER O. D. (NPI 1285652826)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285652826 NPI number — DR. ERIC RICHARD TYLER O. D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TYLER
Provider First Name:
ERIC
Provider Middle Name:
RICHARD
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O. D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TYLER
Provider Other First Name:
ERIC
Provider Other Middle Name:
RICHARD
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
O. D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1285652826
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2990 SHERRY CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLE CANADA
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55117-4639
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
651-206-2418
Provider Business Mailing Address Fax Number:
651-631-2113

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1752 N FRONTAGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HASTINGS
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
651-438-2400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/18/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OPC3617 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: LD28450000 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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