Provider Demographics
NPI:1427286301
Name:MYERS MCCONKEY, TYRA M (OD)
Entity type:Individual
Prefix:
First Name:TYRA
Middle Name:M
Last Name:MYERS MCCONKEY
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:725 WALTHER RD BLDG 100
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-8725
Mailing Address - Country:US
Mailing Address - Phone:770-513-3300
Mailing Address - Fax:678-990-8252
Practice Address - Street 1:725 WALTHER RD BLDG 100
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30046-8725
Practice Address - Country:US
Practice Address - Phone:770-513-3300
Practice Address - Fax:678-990-8252
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002531152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist