DR. Tyler William Ellsworth, OD

NPI #1760034110 in Lithonia, Georgia

Provider Information

NPI Number: 1760034110
Entity Type: Individual
Name: DR. Tyler William Ellsworth, OD
Gender: Not Specified
Sole Proprietor: Yes
Primary Specialty: Optometrist
Credential: OD
Enumeration Date: Jul 15, 2019
Last Updated: Jul 15, 2019

Practice Location

Address: 8075 MALL PKWY STE 103
City: Lithonia
State: Georgia
ZIP Code: 30038-6993
Phone: (770) 484-2955

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X	Primary

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