Active NPI
Tyler Sealock
- Optometrist
- Plymouth, MN
National Provider Identifier
1013845643
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- 4060
- Practice address
- 4455 Highway 169 N
Plymouth, MN 55442-2897 - Phone
- (763) 559-7358
- Fax
- (763) 559-2167
- NPI assigned
- May 13, 2026
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | 4060 | MN | Primary |
Addresses
Primary practice location
4455 Highway 169 N
Plymouth, MN 55442-2897
Mailing address
4455 Highway 169 N
Plymouth, MN 55442-2897
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| STUDENT | MN | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1778630400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1782691200000",
"number": "1013845643",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4455 HIGHWAY 169 N",
"city": "PLYMOUTH",
"state": "MN",
"postal_code": "554422897"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4455 HIGHWAY 169 N",
"city": "PLYMOUTH",
"state": "MN",
"postal_code": "554422897",
"telephone_number": "763-559-7358",
"fax_number": "763-559-2167"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SEALOCK",
"first_name": "TYLER",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2026-05-13",
"last_updated": "2026-06-29",
"certification_date": "2026-06-29",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "MN",
"license": "4060",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plymouth, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.