Provider Demographics
NPI:1285652826
Name:TYLER, ERIC RICHARD (O D)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:RICHARD
Last Name:TYLER
Suffix:
Gender:M
Credentials:O D
Other - Prefix:DR
Other - First Name:ERIC
Other - Middle Name:RICHARD
Other - Last Name:TYLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:O D
Mailing Address - Street 1:2990 SHERRY CT
Mailing Address - Street 2:
Mailing Address - City:LITTLE CANADA
Mailing Address - State:MN
Mailing Address - Zip Code:55117-4639
Mailing Address - Country:US
Mailing Address - Phone:651-206-2418
Mailing Address - Fax:651-631-2113
Practice Address - Street 1:1752 N FRONTAGE RD
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033
Practice Address - Country:US
Practice Address - Phone:651-438-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC3617152W00000X
MNLD28450000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU97894Medicare UPIN