Tyler Justin Stathis, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

002431 Issued in AZ

Practice address

15681 N Hayden Rd Ste 115
Scottsdale, AZ 85260-1959

Phone

(480) 948-1131

NPI assigned

Jun 22, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

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

Specialty

Optometry

Education

Other, 2020

Medicare assignment

May accept Medicare assignment

Group practices

Valley Eye Care Inc.Group PAC ID 1355442807, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Valley Eye Care Inc.

  • Optometrist
  • Phoenix, AZ
  • NPI 1780797613
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1592784000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1632700800000",
    "number": "1457977928",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8612 E SAN FELIPE DR",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852582550",
            "telephone_number": "480-329-7923"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15681 N HAYDEN RD STE 115",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852601959",
            "telephone_number": "480-948-1131"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STATHIS",
        "first_name": "TYLER",
        "middle_name": "JUSTIN",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-06-22",
        "last_updated": "2021-09-27",
        "certification_date": "2021-09-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "AZ",
            "license": "002431",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Start Fresh Recovery Southwest
• Denise M Stassen, PA-C
• Statclinix PLC
• State 48 Home Health of Phoenix LLC
• State 48 Hospice of Phoenix LLC
• Michael Craig Staub, D.C.
• Stay Dripped IV LLC
• Steadfast Integrative Medicine
• Ashton Steadman
• Danielle Alena Stearns, D.O.

• Optometrist in Scottsdale, AZ
• Providers in Scottsdale, AZ by specialty
• Optometrist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2021; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.