NPIMap

Organization Active NPI

Tyler Ridge Vision Care, LTD.

  • Optometrist
  • St Charles, IL
National Provider Identifier
1225052301
Registry record updated Dec 8, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
46-008116 Issued in IL
Legal business name
TYLER RIDGE VISION CARE, LTD.
Practice address
1001 E Main St
#C
Saint Charles, IL 60174-2202
Phone
(630) 584-1111
Fax
(630) 584-1239
NPI assigned
Jul 26, 2006
Last updated
Dec 8, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Douglas Aaron Yuvan, ODNPI 1043234263
Title
President
Phone
(630) 584-1111

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 46-008116 IL Primary

Addresses

Primary practice location

1001 E Main St
#C
Saint Charles, IL 60174-2202

Mailing address

1001 E. Main St.
#C
Saint Charles, IL 60174
Phone (630) 584-1111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040927000477 IL Part B Supplier - Clinic/Group Practice 0042289183 Receives reassigned benefits from 4 practitioners
Practice locations: St Charles, IL

National Provider Directory

National Provider Directory

Locations

1001 E Main St
Ste C
St Charles, IL 60174
Phone (630) 584-1111

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670457600000",
    "number": "1225052301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 E. MAIN ST.",
            "address_2": "#C",
            "city": "SAINT CHARLES",
            "state": "IL",
            "postal_code": "60174",
            "telephone_number": "630-584-1111",
            "fax_number": "630-584-1239"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 E MAIN ST",
            "address_2": "#C",
            "city": "SAINT CHARLES",
            "state": "IL",
            "postal_code": "601742202",
            "telephone_number": "630-584-1111",
            "fax_number": "630-584-1239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TYLER RIDGE VISION CARE, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-26",
        "last_updated": "2022-12-08",
        "certification_date": "2022-12-08",
        "status": "A",
        "authorized_official_last_name": "YUVAN",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_middle_name": "AARON",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "630-584-1111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "OD"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IL",
            "license": "46-008116",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Charles, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.