Provider Demographics
NPI:1235571720
Name:ZELLERS, TYLER (OD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:ZELLERS
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 1:3636 MCKINNEY AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-1443
Mailing Address - Country:US
Mailing Address - Phone:214-252-1800
Mailing Address - Fax:214-252-1801
Practice Address - Street 1:3636 MCKINNEY AVE STE 120
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-1443
Practice Address - Country:US
Practice Address - Phone:214-252-1800
Practice Address - Fax:214-252-1801
Is Sole Proprietor?:No
Enumeration Date:2013-07-24
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8264-T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist