Provider Demographics
NPI:1245669969
Name:GROCE, TYLER (OD)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:
Last Name:GROCE
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 1:902 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:YADKINVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27055-7807
Mailing Address - Country:US
Mailing Address - Phone:336-679-2931
Mailing Address - Fax:336-677-6486
Practice Address - Street 1:800 S STRATFORD RD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-3202
Practice Address - Country:US
Practice Address - Phone:336-765-5788
Practice Address - Fax:336-765-5584
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2332152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist