Provider Demographics
NPI:1992493829
Name:TYLER GROCE OD, PLLC
Entity type:Organization
Organization Name:TYLER GROCE OD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:GROCE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:336-466-5511
Mailing Address - Street 1:PO BOX 1426
Mailing Address - Street 2:
Mailing Address - City:CLEMMONS
Mailing Address - State:NC
Mailing Address - Zip Code:27012-1426
Mailing Address - Country:US
Mailing Address - Phone:336-466-5511
Mailing Address - Fax:
Practice Address - Street 1:6301 STADIUM DR UNIT D
Practice Address - Street 2:
Practice Address - City:CLEMMONS
Practice Address - State:NC
Practice Address - Zip Code:27012-8766
Practice Address - Country:US
Practice Address - Phone:336-766-7373
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-27
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty