Provider Demographics
NPI:1144379751
Name:TILSON, ALAN ROY (OD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:ROY
Last Name:TILSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4070 N BELT LINE RD STE 168
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-5010
Mailing Address - Country:US
Mailing Address - Phone:972-258-2020
Mailing Address - Fax:972-258-2030
Practice Address - Street 1:4070 N BELT LINE RD STE 168
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75038-5010
Practice Address - Country:US
Practice Address - Phone:972-258-2020
Practice Address - Fax:972-258-2030
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3102T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist