Individual provider Active NPI

Kerry N Tyler, O.D.

  • Optometrist
  • Castle Rock, CO
National Provider Identifier
1396707816
Registry record updated Oct 19, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
CO0842 Issued in CO
Practice address
409 S Wilcox St
Ste a
Castle Rock, CO 80104-1962
Phone
(303) 688-4044
Fax
(303) 688-4028
NPI assigned
Apr 3, 2006
Last updated
Oct 19, 2016By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 19, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X CO0842 CO Primary

Addresses

Primary practice location

409 S Wilcox St
Ste a
Castle Rock, CO 80104-1962

Mailing address

409 S Wilcox St
Castle Rock, CO 80104-1962
Phone (303) 688-4044

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110726000953 CO Practitioner - Optometry 1850401860 Reassigns benefits to 1 organization
Practice locations: Castle Rock, CO

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Pacific University - College of Optometry, 1970
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Front Range Family EyecareGroup PAC ID 8820090954, 9 clinicians

Practice addresses (Care Compare)

4920 S Yosemite St
Suite C5
Greenwood Village, CO 80111-1352
Phone (303) 220-5100

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery12

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
CO0842COMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Front Range Family Eyecare Optometrist CurrentSince Mar 16, 2019 Accepting new patients

Locations

409 S Wilcox St
Ste A
Castle Rock, CO 80104
Phone (303) 688-4044

4809 Argonne St
Ste 250
Denver, CO 80249
Phone (720) 353-4972

4920 S Yosemite St
Ste C5
Greenwood Village, CO 80111
Phone (303) 220-5100

9045 Forsstrom Dr
Ste 100
Lone Tree, CO 80124
Phone (303) 858-8474

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1144022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476835200000",
    "number": "1396707816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "409 S WILCOX ST",
            "city": "CASTLE ROCK",
            "state": "CO",
            "postal_code": "801041962",
            "telephone_number": "303-688-4044",
            "fax_number": "303-688-4028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "409 S WILCOX ST",
            "address_2": "STE A",
            "city": "CASTLE ROCK",
            "state": "CO",
            "postal_code": "801041962",
            "telephone_number": "303-688-4044",
            "fax_number": "303-688-4028"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TYLER",
        "first_name": "KERRY",
        "middle_name": "N",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-04-03",
        "last_updated": "2016-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CO",
            "license": "CO0842",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Castle Rock, CO

Sources for this page

Verify at the official NPI Registry.