Healthcare Provider Details

I. General information

NPI: 1689498982
Provider Name (Legal Business Name): TYLOCK-GEORGE COSMETIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2024
Last Update Date: 11/18/2024
Certification Date: 11/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 N MACARTHUR BLVD
IRVING TX
75062-4451
US

IV. Provider business mailing address

3100 N MACARTHUR BLVD
IRVING TX
75062-4451
US

V. Phone/Fax

Practice location:
  • Phone: 972-258-6400
  • Fax:
Mailing address:
  • Phone: 972-258-6400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QS0132X
TaxonomyOphthalmologic Surgery Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TAJ NASSER
Title or Position: MEDICAL DIRECTOR
Credential:
Phone: 972-258-6400