MEDICARE: TYLER JAMES KULL OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	35671	CA

General Provider Information

NPI Number	:	1134960487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TYLER JAMES KULL OD

Provider Business Mailing Address
First Line	:	4000 CALLE TECATE STE 100
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93012-5283
Country	:	US
Telephone Number	:	805-482-1136
Fax Number	:

Provider Business Practice Location Address
First Line	:	4000 CALLE TECATE STE 100
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93012-5283
Country	:	US
Telephone Number	:	805-482-1136
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2024
Last Update Date	:	11/25/2024

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