MEDICARE: DR. THOMAS TYLER M.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	207W00000X	Ophthalmology Physician	C50482	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972587459
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS TYLER M.D.

Provider Business Mailing Address
First Line	:	1140 LAUREL ST
Second Line	:	STE. A
City	:	SAN CARLOS
State	:	CA
Zip	:	94070-5009
Country	:	US
Telephone Number	:	650-551-1103
Fax Number	:	650-551-1104

Provider Business Practice Location Address
First Line	:	1140 LAUREL ST
Second Line	:	STE. A
City	:	SAN CARLOS
State	:	CA
Zip	:	94070-5009
Country	:	US
Telephone Number	:	650-551-1103
Fax Number	:	650-551-1104

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

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	07/08/2007

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