Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207W00000X | Ophthalmologist | 35131374 | OH |
NPI | 1003159880 |
---|---|
Provider Name | Dr. Tyler Dean Oostra |
First Address | Columbus, OH 43202-1559 |
Second Address | Columbus, OH 43212-3153 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2013 |
Last Update Date | 17/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0229987 | (05) | OH |