Provider Demographics
NPI:1891216388
Name:ROBERTSON, TYLER (OD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:ROBERTSON
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 1:833 AVENUE N
Mailing Address - Street 2:
Mailing Address - City:ELY
Mailing Address - State:NV
Mailing Address - Zip Code:89301-2904
Mailing Address - Country:US
Mailing Address - Phone:775-293-3037
Mailing Address - Fax:
Practice Address - Street 1:1250 GREAT BASIN BLVD
Practice Address - Street 2:
Practice Address - City:ELY
Practice Address - State:NV
Practice Address - Zip Code:89301-2096
Practice Address - Country:US
Practice Address - Phone:775-289-2580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-05
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV924152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist