Healthcare Provider Details

I. General information

NPI: 1790862019
Provider Name (Legal Business Name): MICHAEL E TYNER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

704 BROOKWOOD VLG
BIRMINGHAM AL
35209-4549
US

IV. Provider business mailing address

1619 ROSELAND DR
BIRMINGHAM AL
35209-3953
US

V. Phone/Fax

Practice location:
  • Phone: 205-879-2512
  • Fax: 205-870-3009
Mailing address:
  • Phone: 205-871-8668
  • Fax: 205-870-3009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberS-598-TA-717
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: