Provider Demographics
NPI:1053609420
Name:MAYES, TYLER NEAL (OD)
Entity type:Individual
Prefix:
First Name:TYLER
Middle Name:NEAL
Last Name:MAYES
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 1:1601 W EVERLY BROTHERS BLVD
Mailing Address - Street 2:
Mailing Address - City:CENTRAL CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42330-2707
Mailing Address - Country:US
Mailing Address - Phone:270-754-4515
Mailing Address - Fax:270-754-2547
Practice Address - Street 1:1601 W EVERLY BROTHERS BLVD
Practice Address - Street 2:
Practice Address - City:CENTRAL CITY
Practice Address - State:KY
Practice Address - Zip Code:42330-2707
Practice Address - Country:US
Practice Address - Phone:270-754-4515
Practice Address - Fax:270-754-2547
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2016-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1836DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist