Tyler William Ellsworth, OD Valid NPI
Individual provider · Optometrist · Lithonia, GA
- NPI
- 1760034110
- Type
- Individual (Type 1)
- Primary specialty
- Optometrist
- Specialty group
- Eye and Vision Services Providers
- Taxonomy code
- 152W00000X
- License number
- OPT003180 (GA)
- Sex
- Male
- Sole proprietor
- Yes
- Enumerated
- 2019-07-15
- Last updated
- 2019-07-15
Practice location
8075 Mall Pkwy Ste 103
Lithonia, GA 30038-6993
(770) 484-2955