Provider Demographics
NPI:1134960487
Name:KULL, TYLER JAMES (OD)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:JAMES
Last Name:KULL
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 1:4000 CALLE TECATE STE 100
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93012-5283
Mailing Address - Country:US
Mailing Address - Phone:805-482-1136
Mailing Address - Fax:
Practice Address - Street 1:4000 CALLE TECATE STE 100
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93012-5283
Practice Address - Country:US
Practice Address - Phone:805-482-1136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-03
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35671152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist