Provider Demographics
NPI:1336127505
Name:TYLER, JOI L (OD)
Entity Type:Individual
Prefix:DR
First Name:JOI
Middle Name:L
Last Name:TYLER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 CLOISTER PL
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29210-5849
Mailing Address - Country:US
Mailing Address - Phone:803-750-1391
Mailing Address - Fax:
Practice Address - Street 1:3400 FOREST DR
Practice Address - Street 2:SUITE 2050
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-4041
Practice Address - Country:US
Practice Address - Phone:803-790-0000
Practice Address - Fax:803-790-1125
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2010-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1037152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCU608790281Medicare ID - Type Unspecified