Provider Demographics
NPI:1114996220
Name:TINSLEY, TYLER N (OD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:N
Last Name:TINSLEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:TYLER
Other - Middle Name:N
Other - Last Name:KRAMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:2400 LUCY LEE PKWY STE E
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2427
Mailing Address - Country:US
Mailing Address - Phone:573-686-3991
Mailing Address - Fax:573-686-3992
Practice Address - Street 1:2400 LUCY LEE PKWY STE E
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2427
Practice Address - Country:US
Practice Address - Phone:573-686-3991
Practice Address - Fax:573-686-3992
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004003243152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO314467705Medicaid
MOV00271Medicare UPIN
MO000025657Medicare PIN