Provider Demographics
NPI:1841727286
Name:BOONE, TYLER ROSS (OD)
Entity type:Individual
Prefix:DR
First Name:TYLER
Middle Name:ROSS
Last Name:BOONE
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 1:1441 NEW HIGHWAY 96 W STE 3
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37064-4831
Mailing Address - Country:US
Mailing Address - Phone:931-217-0979
Mailing Address - Fax:
Practice Address - Street 1:1441 NEW HIGHWAY 96 W STE 3
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37064-4831
Practice Address - Country:US
Practice Address - Phone:615-560-8245
Practice Address - Fax:615-560-8249
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-16
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALR-274-TA-B65152W00000X
TN3375152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ031644Medicaid