Healthcare Provider Details

I. General information

NPI: 1568454601
Provider Name (Legal Business Name): TYLER M AMOS OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 09/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 OLD HIGHWAY 431 SUITE C
OWENS CROSS ROADS AL
35763-9281
US

IV. Provider business mailing address

184 OLD HIGHWAY 431 SUITE C
OWENS CROSS ROADS AL
35763-9281
US

V. Phone/Fax

Practice location:
  • Phone: 256-469-6073
  • Fax: 256-469-6085
Mailing address:
  • Phone: 256-469-6073
  • Fax: 256-469-6085

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberMA0745705
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: