Provider Demographics
NPI:1285205997
Name:JOSEPH, EDWARD TYLER I (OD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:TYLER
Last Name:JOSEPH
Suffix:I
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 1:351 RIVER HILL DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7397
Mailing Address - Country:US
Mailing Address - Phone:606-326-9321
Mailing Address - Fax:
Practice Address - Street 1:351 RIVER HILL DR
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7397
Practice Address - Country:US
Practice Address - Phone:606-326-9321
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-03
Last Update Date:2021-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY2228DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist