MEDICARE: DR. TYLER DOERSAM 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	046010839	IL

General Provider Information

NPI Number	:	1417365123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TYLER DOERSAM O.D.

Provider Business Mailing Address
First Line	:	20505 RAND RD
Second Line	:	STE 500
City	:	KILDEER
State	:	IL
Zip	:	60047-3004
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	118 LAKESIDE DR
Second Line	:	APT 434
City	:	SAINT CHARLES
State	:	IL
Zip	:	60174-7905
Country	:	US
Telephone Number	:	815-821-3088
Fax Number	:

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

Provider Enumeration Date	:	07/25/2014
Last Update Date	:	03/11/2016

Similar Medicare Providers

1326970864 — ANAIZ AENGELIZ ALI RBT
Practice Location Address:

4940 SPIRAL WAY
SAINT CLOUD, FL
34771-7905

Practice Phone: 689-245-4499
Practice Fax:

1487781597 — DR. TESSA GARDNER M.D.
Practice Location Address:

7905 BLACKBERRY AVE
SAINT LOUIS, MO
63130-2710

Practice Phone: 314-727-9101
Practice Fax:

1104190669 — JULIE C BARR LPC
Practice Location Address:

7905 BIG BEND BLVD , SUITE 206
SAINT LOUIS, MO
63119-2715

Practice Phone: 314-606-6763
Practice Fax:

1265365191 — KYLIE ANN PYTLAK
Practice Location Address:

255 38TH AVE
SAINT CHARLES, IL
60174-5411

Practice Phone: 630-509-8700
Practice Fax:

1487627170 — MR. HERMAN PAUL LANGNER M.D.
Practice Location Address:

502 W MAIN ST
SAINT CHARLES, IL
60174-1839

Practice Phone: 630-377-7225
Practice Fax: 630-584-0808

1285609420 — STACI M ROTH OTR
Practice Location Address:

1601 E MAIN ST STE G
SAINT CHARLES, IL
60174-2431

Practice Phone: 630-880-0993
Practice Fax:

Directions to “ DR. TYLER DOERSAM O.D.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.