Provider Demographics
NPI:1710407564
Name:PIETRYKOWSKI, TYLER CHARLES (OD)
Entity Type:Individual
Prefix:DR
First Name:TYLER
Middle Name:CHARLES
Last Name:PIETRYKOWSKI
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 1:1746 E THORNTON RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:IN
Mailing Address - Zip Code:47250-9569
Mailing Address - Country:US
Mailing Address - Phone:812-599-6158
Mailing Address - Fax:
Practice Address - Street 1:2580 MICHIGAN RD STE 2
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:IN
Practice Address - Zip Code:47250-2492
Practice Address - Country:US
Practice Address - Phone:812-265-6222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-22
Last Update Date:2017-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004040A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist