Provider Demographics
NPI:1396253191
Name:TYLER YOUNG, O.D., P.A.
Entity type:Organization
Organization Name:TYLER YOUNG, O.D., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:ROSS
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:913-808-2020
Mailing Address - Street 1:12129 SHAWNEE MISSION PKWY
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:KS
Mailing Address - Zip Code:66216-1829
Mailing Address - Country:US
Mailing Address - Phone:913-808-2020
Mailing Address - Fax:913-298-2634
Practice Address - Street 1:12129 SHAWNEE MISSION PKWY
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:KS
Practice Address - Zip Code:66216
Practice Address - Country:US
Practice Address - Phone:913-808-2020
Practice Address - Fax:913-298-2634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-14
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1886152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty