Healthcare Provider Details

I. General information

NPI: 1700260072
Provider Name (Legal Business Name): TYLER ALLEN CHARTIER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/16/2015
Last Update Date: 12/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 WEST U.S. HIGHWAY 2
NORWAY MI
49870
US

IV. Provider business mailing address

525 WEST U.S. HIGHWAY 2
NORWAY MI
49870
US

V. Phone/Fax

Practice location:
  • Phone: 906-563-5711
  • Fax: 906-563-9196
Mailing address:
  • Phone: 906-563-5711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4901004915
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: