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General NPI Number Information
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NPI Number | 1568813806
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Entity Type | Individual
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Provider Name | TYLER J THORNTON OD
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Gender | Male
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Dates
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Enumeration Date | 06/28/2016
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 2728 SUNSET BLVD STE 106
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City | WEST COLUMBIA
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State | SC
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Zip | 29169-4836
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Country | US
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Telephone | 803-314-9760
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Fax | 803-314-9761
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Provider Business Mailing Address
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Address Line | 5581 KYLE CENTRE DR SUITE 101
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City | KYLE
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State | TX
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Zip | 78640-6734
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Country | US
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Telephone | 904-891-4274
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 9801TG
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2391
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License Number State | SC
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