Provider Demographics
NPI:1881117570
Name:CROUSE, TYLER (OD)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:
Last Name:CROUSE
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 1:555 GETTYSBURG PIKE STE C200
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-5205
Mailing Address - Country:US
Mailing Address - Phone:717-796-2000
Mailing Address - Fax:717-796-2015
Practice Address - Street 1:555 GETTYSBURG PIKE STE C200
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-5205
Practice Address - Country:US
Practice Address - Phone:717-796-2000
Practice Address - Fax:717-796-2015
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-25
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003311152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty