Provider Demographics
NPI:1679944177
Name:MAUTINO, TYLER (OD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:MAUTINO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:60 HATCH RUN RD
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:PA
Mailing Address - Zip Code:16365-5249
Mailing Address - Country:US
Mailing Address - Phone:724-825-3691
Mailing Address - Fax:814-726-9090
Practice Address - Street 1:60 HATCH RUN RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-5249
Practice Address - Country:US
Practice Address - Phone:724-825-3691
Practice Address - Fax:814-726-9090
Is Sole Proprietor?:No
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003123152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist