MEDICARE: DR. JOHN DAVID TYBOR O.D.

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	10658T	TX

General Provider Information

NPI Number	:	1396472825
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN DAVID TYBOR O.D.

Provider Business Mailing Address
First Line	:	6000 W WILLIAM CANNON DR STE 100
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78749-1975
Country	:	US
Telephone Number	:	512-288-0444
Fax Number	:

Provider Business Practice Location Address
First Line	:	6000 W WILLIAM CANNON DR STE 100
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78749-1975
Country	:	US
Telephone Number	:	512-288-0444
Fax Number	:

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

Provider Enumeration Date	:	08/04/2022
Last Update Date	:	08/04/2022

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