Provider Demographics
NPI:1760970248
Name:MCLEMORE, TYLER BRANDON (OD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:BRANDON
Last Name:MCLEMORE
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 1:108 FUTURITY LN
Mailing Address - Street 2:
Mailing Address - City:BROCK
Mailing Address - State:TX
Mailing Address - Zip Code:76087-4606
Mailing Address - Country:US
Mailing Address - Phone:559-538-4062
Mailing Address - Fax:
Practice Address - Street 1:601 FM 1821
Practice Address - Street 2:
Practice Address - City:MINERAL WELLS
Practice Address - State:TX
Practice Address - Zip Code:76067-9119
Practice Address - Country:US
Practice Address - Phone:940-222-8435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33915TLG152W00000X
TX9831TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist