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General NPI Number Information
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NPI Number | 1588390421
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Entity Type | Individual
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Provider Name | TYLER RYAN SCOTT OD
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Gender | Male
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Dates
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Enumeration Date | 07/25/2022
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Last Update Date | 07/25/2022
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Provider Practice Location Address
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Address Line | 116 E ELLISON ST STE C
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City | BURLESON
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State | TX
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Zip | 76028-4286
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Country | US
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Telephone | 817-295-9696
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 W ROSEDALE ST APT 1412
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City | FORT WORTH
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State | TX
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Zip | 76104-4895
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Country | US
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Telephone | 951-852-8138
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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 | 10561T
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License Number State | TX
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