Provider Demographics
NPI:1568489094
Name:TYCHSEN, ROBERT LAWRENCE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LAWRENCE
Last Name:TYCHSEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-454-6026
Mailing Address - Fax:314-454-2368
Practice Address - Street 1:1 CHILDRENS PL
Practice Address - Street 2:STE 3110
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1002
Practice Address - Country:US
Practice Address - Phone:314-454-6026
Practice Address - Fax:314-454-2368
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2024-04-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MOR5J00207W00000X, 207WX0110X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0110XAllopathic & Osteopathic PhysiciansOphthalmologyPediatric Ophthalmology and Strabismus Specialist
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202703609Medicaid
ILENROLLEDMedicaid
MO017010103Medicaid
IL$$$$$$$$$Medicaid