Provider Demographics
NPI:1679576920
Name:TYLOCK, GARY RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:RICHARD
Last Name:TYLOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3100 N MACARTHUR BLVD
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75062
Mailing Address - Country:US
Mailing Address - Phone:972-258-6400
Mailing Address - Fax:972-570-1103
Practice Address - Street 1:3100 N MACARTHUR BLVD
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-4451
Practice Address - Country:US
Practice Address - Phone:972-258-6400
Practice Address - Fax:972-570-1103
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2869207WX0120X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1770753519OtherGROUP NPI