Provider Demographics
NPI:1275269813
Name:RIDDER, TYLER JAMES (OD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:JAMES
Last Name:RIDDER
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 1:460 E NINE MILE RD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32514-1441
Mailing Address - Country:US
Mailing Address - Phone:850-477-1499
Mailing Address - Fax:850-479-3359
Practice Address - Street 1:2491 S FERDON BLVD
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-8463
Practice Address - Country:US
Practice Address - Phone:850-682-4014
Practice Address - Fax:850-682-0387
Is Sole Proprietor?:No
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC6157152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist