Provider Demographics
NPI:1780023978
Name:SPEELMAN, TYLER JAMES (OD)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:JAMES
Last Name:SPEELMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1509 STATE ROUTE 716
Mailing Address - Street 2:
Mailing Address - City:MARIA STEIN
Mailing Address - State:OH
Mailing Address - Zip Code:45860-9713
Mailing Address - Country:US
Mailing Address - Phone:419-733-9395
Mailing Address - Fax:
Practice Address - Street 1:201 S 2ND ST
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:OH
Practice Address - Zip Code:45828-1747
Practice Address - Country:US
Practice Address - Phone:419-678-3016
Practice Address - Fax:419-678-8849
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6234152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH227132Medicare UPIN