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General NPI Number Information
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NPI Number | 1821277468
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Entity Type | Organization
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Legal Business Name | JARED TYHURST OD PC
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Dates
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Enumeration Date | 10/31/2007
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 1614 E MAIN ST
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City | LEBANON
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State | VA
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Zip | 24266-3446
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Country | US
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Telephone | 276-889-1315
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2020
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City | LEBANON
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State | VA
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Zip | 24266-2020
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JARED CHARLES TYHURST
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Credential | OD
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Telephone | 276-525-0602
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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 |
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License Number State | VA
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