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General NPI Number Information
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NPI Number | 1972988525
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Entity Type | Individual
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Provider Name | TYLER XAVIER DE SOUZA O.D.
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Gender | Male
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Dates
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Enumeration Date | 07/24/2015
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Last Update Date | 05/30/2019
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Provider Practice Location Address
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Address Line | 1831 E BUENA VISTA DR
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City | TEMPE
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State | AZ
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Zip | 85284-2501
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Country | US
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Telephone | 929-335-1243
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Fax |
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Provider Business Mailing Address
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Address Line | 6895 E CAMELBACK RD UNIT 3015
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City | SCOTTSDALE
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State | AZ
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Zip | 85251-2480
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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 |
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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 | TUV008345
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License Number State | NY
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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 | OPT-002306
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License Number State | AZ
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