Provider Demographics
NPI:1548572811
Name:YOUNG, TYLER ROSS (OD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:ROSS
Last Name:YOUNG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12129 SHAWNEE MISSION PKWY
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66216-1829
Mailing Address - Country:US
Mailing Address - Phone:913-808-2020
Mailing Address - Fax:913-298-2634
Practice Address - Street 1:12129 SHAWNEE MISSION PKWY
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66216
Practice Address - Country:US
Practice Address - Phone:913-808-2020
Practice Address - Fax:913-298-2634
Is Sole Proprietor?:No
Enumeration Date:2010-07-02
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010020777152W00000X
KS1886152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management