Tyler Wayne Wyatt, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

9050293-9934 Issued in UT

Practice address

500 Foothill Dr
Optometry Department (112)
Salt Lake City, UT 84148-0001

Phone

(801) 582-1565

NPI assigned

Jun 11, 2014

Last updated

Jun 11, 2014By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• Frank a Siddoway OD PC

  • Optometrist
  • Provo, UT
  • NPI 1073786505
  NPD (past)

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

{
    "created_epoch": "1402444800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402444800000",
    "number": "1407260094",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 W 3100 S",
            "city": "BOUNTIFUL",
            "state": "UT",
            "postal_code": "840106521",
            "telephone_number": "702-513-8201"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 FOOTHILL DR",
            "address_2": "OPTOMETRY DEPARTMENT (112)",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841480001",
            "telephone_number": "801-582-1565"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WYATT",
        "first_name": "TYLER",
        "middle_name": "WAYNE",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-11",
        "last_updated": "2014-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "UT",
            "license": "9050293-9934",
            "primary": true
        },
        {
            "code": "152WC0802X",
            "taxonomy_group": "",
            "desc": "Optometrist, Corneal and Contact Management",
            "state": "UT",
            "license": "9050293-9934",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christian Hyde Wunderli
• Kate Wunderli
• Alisha Wursten, NP
• Jamie Ann Wuthrich
• Jason Floyd Wyasket, RN
• Whitney Wyatt
• Katherine Wycoff, OTR/L
• Dennis Jon Wyman, M.D.
• Bret Wynder, PHARMD
• Esther Wynder

• Optometrist in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Optometrist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.