Provider Demographics
NPI:1669114252
Name:HORTON, TYLER BROOKS (OD)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:BROOKS
Last Name:HORTON
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 1:2801 N LOS FELICES CIR E
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-1499
Mailing Address - Country:US
Mailing Address - Phone:805-903-3518
Mailing Address - Fax:
Practice Address - Street 1:82227 US HIGHWAY 111 STE B2
Practice Address - Street 2:
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5668
Practice Address - Country:US
Practice Address - Phone:760-347-6636
Practice Address - Fax:844-833-6644
Is Sole Proprietor?:No
Enumeration Date:2022-04-13
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA0000152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program