Provider Demographics
NPI:1942930599
Name:SPILMAN, TYLER DEAN (OD)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:DEAN
Last Name:SPILMAN
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 1:1501 5TH ST UNIT 547
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95814-5453
Mailing Address - Country:US
Mailing Address - Phone:916-479-3518
Mailing Address - Fax:
Practice Address - Street 1:125 N LINCOLN ST STE A
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:CA
Practice Address - Zip Code:95620-3259
Practice Address - Country:US
Practice Address - Phone:707-678-3055
Practice Address - Fax:707-678-9265
Is Sole Proprietor?:No
Enumeration Date:2022-06-15
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35432TLG152W00000X
CATLG35432152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist