Provider Demographics
NPI:1225052301
Name:TYLER RIDGE VISION CARE, LTD.
Entity Type:Organization
Organization Name:TYLER RIDGE VISION CARE, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:AARON
Authorized Official - Last Name:YUVAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:630-584-1111
Mailing Address - Street 1:1001 E. MAIN ST.
Mailing Address - Street 2:#C
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60174
Mailing Address - Country:US
Mailing Address - Phone:630-584-1111
Mailing Address - Fax:630-584-1239
Practice Address - Street 1:1001 E MAIN ST
Practice Address - Street 2:#C
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60174-2202
Practice Address - Country:US
Practice Address - Phone:630-584-1111
Practice Address - Fax:630-584-1239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL46-008116152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0829090001Medicare NSC