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General NPI Number Information
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NPI Number | 1891216388
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Entity Type | Individual
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Provider Name | TYLER ROBERTSON OD
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Gender | Male
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Dates
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Enumeration Date | 07/05/2017
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Last Update Date | 02/15/2023
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Provider Practice Location Address
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Address Line | 1250 GREAT BASIN BLVD
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City | ELY
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State | NV
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Zip | 89301-2096
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Country | US
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Telephone | 775-289-2580
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Fax |
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Provider Business Mailing Address
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Address Line | 833 AVENUE N
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City | ELY
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State | NV
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Zip | 89301-2904
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Country | US
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Telephone | 775-293-3037
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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 | 924
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License Number State | NV
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