Provider Demographics
NPI:1073141081
Name:KERR, TYLER TRAVIS (OD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:TRAVIS
Last Name:KERR
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 LOWER COVE RUN RD
Mailing Address - Street 2:
Mailing Address - City:MATHIAS
Mailing Address - State:WV
Mailing Address - Zip Code:26812-8230
Mailing Address - Country:US
Mailing Address - Phone:304-490-9545
Mailing Address - Fax:
Practice Address - Street 1:1945 CEI DR
Practice Address - Street 2:
Practice Address - City:BLUE ASH
Practice Address - State:OH
Practice Address - Zip Code:45242-5664
Practice Address - Country:US
Practice Address - Phone:513-984-5133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-27
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOPT.006889152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist