Individual provider Active NPI

Julie A Tyler, O.D.

  • Optometrist
  • Anaheim, CA
National Provider Identifier
1396821955
Registry record updated Feb 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
34495 Issued in CA
Practice address
5460 E la Palma Ave
Anaheim, CA 92807-2023
Phone
(714) 463-7500
Fax
(714) 992-7850
NPI assigned
Oct 27, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 13, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X OPC3059 FL
Optometrist 152W00000X 34495 CA Primary

Addresses

Primary practice location

5460 E la Palma Ave
Anaheim, CA 92807-2023

Mailing address

5460 E la Palma Ave
Anaheim, CA 92807-2023
Phone (714) 463-7500

Other practice location 1

3200 S University Dr
NSU College of Optometry Suite 1402
Davie, FL 33328-2018
Phone (954) 262-1402

Other identifiers 1

IdentifierTypeStateIssuer
620504600MedicaidFL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL, CA2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20120213000515 FL Practitioner - Optometry 8921265356 Reassigns benefits to 1 organization
I20200601002916 CA Practitioner - Optometry 8921265356 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
Indiana University - School of Optometry, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Marshall B Ketchum UniversityGroup PAC ID 9739075177, 56 clinicians

Practice addresses (Care Compare)

5460 E la Palma Ave
Anaheim, CA 92807-2023
Phone (714) 463-7505

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
OPC3059FLMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Marshall B. Ketchum University CurrentSince Mar 1, 2020 Accepting new patients
Nova Southeastern University, Inc CurrentSince Jul 18, 1999 Accepting new patients
Nova Southeastern University, Inc Optometrist Current Accepting new patients
Nova Southeastern University Inc. CurrentSince Jul 18, 1999 Accepting new patients
Marshall B. Ketchum University Optometrist CurrentSince Mar 1, 2020 Accepting new patients
Nova Southeastern University, Inc Past Accepting new patients

Locations

5460 E La Palma Ave
Anaheim, CA 92807
Phone (714) 463-7500

3200 S University Dr
Ste 1402
Davie, FL 33328
Phone (954) 262-1402

3200 S University Dr
Davie, FL 33328
Phone (954) 262-1250

650 N Andrews Ave
Ft Lauderdale, FL 33311
Phone (954) 463-4213

1111 W Broward Blvd
Ft Lauderdale, FL 33312
Phone (954) 463-7313

1750 NE 167th St
North Miami Beach, FL 33162
Phone (305) 949-4000

Interoperability endpoints

  • FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/

Organizations & group practices 6

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": "1161907200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1581552000000",
    "number": "1396821955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5460 E LA PALMA AVE",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928072023",
            "telephone_number": "714-463-7500",
            "fax_number": "714-992-7850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5460 E LA PALMA AVE",
            "city": "ANAHEIM",
            "state": "CA",
            "postal_code": "928072023",
            "telephone_number": "714-463-7500",
            "fax_number": "714-992-7850"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3200 S University Dr",
            "address_2": "NSU College of Optometry Suite 1402",
            "address_purpose": "LOCATION",
            "city": "Davie",
            "state": "FL",
            "postal_code": "333282018",
            "country_code": "US",
            "telephone_number": "954-262-1402",
            "fax_number": "954-262-1818",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TYLER",
        "first_name": "JULIE",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-27",
        "last_updated": "2020-02-13",
        "certification_date": "2020-02-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC3059",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "34495",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "620504600",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Anaheim, CA

Sources for this page

Verify at the official NPI Registry.