MEDICARE: GARY R TYLOCK MD PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207WX0009X	Glaucoma Specialist (Ophthalmology) Physician
2	207WX0120X	Cornea and External Diseases Specialist Physician
3	207W00000X	Ophthalmology Physician

General Provider Information

NPI Number	:	1770753519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARY R TYLOCK MD PA

Provider Business Mailing Address
First Line	:	3100 N MACARTHUR BLVD
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75062-4451
Country	:	US
Telephone Number	:	972-258-6400
Fax Number	:	972-570-1103

Provider Business Practice Location Address
First Line	:	3100 N MACARTHUR BLVD
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75062-4451
Country	:	US
Telephone Number	:	972-258-6400
Fax Number	:	972-570-1103

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MR. GRANT NATHAN CARROLL
Credential	:
Telephone Number	:	972-258-6400

Provider Enumeration Date	:	03/07/2008
Last Update Date	:	07/16/2024

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Directions to “GARY R TYLOCK MD PA ” Practice Location

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