MEDICARE: DR. TYLER KENNETH BAARS OD

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	046010599	IL
2	152W00000X	Optometrist	3432	MN
3	152W00000X	Optometrist	MN3432	MN

General Provider Information

NPI Number	:	1861747305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TYLER KENNETH BAARS OD

Provider Business Mailing Address
First Line	:	2405 HENNEPIN AVE
Second Line	:
City	:	MPLS
State	:	MN
Zip	:	55405-2606
Country	:	US
Telephone Number	:	612-584-4142
Fax Number	:	612-584-4147

Provider Business Practice Location Address
First Line	:	2405 HENNEPIN AVE
Second Line	:
City	:	MPLS
State	:	MN
Zip	:	55405-2606
Country	:	US
Telephone Number	:	612-584-4142
Fax Number	:	612-584-4147

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/20/2012
Last Update Date	:	12/04/2020

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