Provider Demographics
NPI:1508585860
Name:CLAIRMONT, TYLER CHARLES
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:CHARLES
Last Name:CLAIRMONT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E CENTURY AVE
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-0400
Mailing Address - Country:US
Mailing Address - Phone:701-222-1420
Mailing Address - Fax:
Practice Address - Street 1:111 E CENTURY AVE
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-0400
Practice Address - Country:US
Practice Address - Phone:701-222-1420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND979152W00000X
ND797152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist