Provider Demographics
NPI:1255303442
Name:DAVID W TYBOR OD PC
Entity Type:Organization
Organization Name:DAVID W TYBOR OD PC
Other - Org Name:OAK HILL EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE ASSISTANT
Authorized Official - Prefix:MISS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:R
Authorized Official - Last Name:HARPER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-288-0444
Mailing Address - Street 1:6000 W WM CANNON
Mailing Address - Street 2:BLDG A STE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749
Mailing Address - Country:US
Mailing Address - Phone:512-288-0444
Mailing Address - Fax:512-288-1009
Practice Address - Street 1:6000 W WILLIAM CANNON DR
Practice Address - Street 2:BLDG A STE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-1975
Practice Address - Country:US
Practice Address - Phone:512-288-0444
Practice Address - Fax:512-288-1009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3233TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E28COtherBLUE CROSS BLUE SHIELD
TX1123507Medicaid
TX00E28COtherBLUE CROSS BLUE SHIELD
TXT16860Medicare UPIN