Provider Demographics
NPI:1689340564
Name:AGEE, TYRUS (OD)
Entity Type:Individual
Prefix:DR
First Name:TYRUS
Middle Name:
Last Name:AGEE
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 1:1600 19TH ST SW
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35211-4616
Mailing Address - Country:US
Mailing Address - Phone:504-650-4562
Mailing Address - Fax:
Practice Address - Street 1:3477 LOWERY PKWY STE 137
Practice Address - Street 2:
Practice Address - City:FULTONDALE
Practice Address - State:AL
Practice Address - Zip Code:35068-1687
Practice Address - Country:US
Practice Address - Phone:205-946-2720
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-19
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS-E91-TA-C39152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist