Provider Demographics
NPI:1235285883
Name:TYSINGER, JAMES W JR (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:TYSINGER
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-2702
Mailing Address - Country:US
Mailing Address - Phone:530-529-4733
Mailing Address - Fax:530-529-1842
Practice Address - Street 1:345 HICKORY ST
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-2702
Practice Address - Country:US
Practice Address - Phone:530-529-4733
Practice Address - Fax:530-529-1842
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC37451207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C345100Medicaid
CAA36630Medicare UPIN
CA00C374511Medicare PIN