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NPI Code Detail

MEDICARE: DR. TYLER S ROSE OD

MEDICARE: DR. TYLER S ROSE 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
1152W00000XOptometrist905NV
2152W00000XOptometrist4901005104MI

General Provider Information

NPI Number : 1942668389
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TYLER S ROSE OD
Provider Business Mailing Address
First Line : PO BOX 208177
Second Line :
City : DALLAS
State : TX
Zip : 75320-8177
Country : US
Telephone Number : 636-200-4393
Fax Number : 636-527-0766
Provider Business Practice Location Address
First Line : 330 W LAKE LANSING RD
Second Line :
City : EAST LANSING
State : MI
Zip : 48823-8527
Country : US
Telephone Number : 517-337-8182
Fax Number : 517-332-0038
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2016
Last Update Date : 11/30/2021

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