Provider Demographics
NPI:1568813806
Name:THORNTON, TYLER J (OD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:J
Last Name:THORNTON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5581 KYLE CENTRE DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-6734
Mailing Address - Country:US
Mailing Address - Phone:904-891-4274
Mailing Address - Fax:
Practice Address - Street 1:23C FIELDSTONE CMNS
Practice Address - Street 2:
Practice Address - City:TOLLAND
Practice Address - State:CT
Practice Address - Zip Code:06084-3422
Practice Address - Country:US
Practice Address - Phone:860-871-6507
Practice Address - Fax:860-871-5765
Is Sole Proprietor?:No
Enumeration Date:2016-06-28
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9801TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist