Individual
DR. TYLOR PRAVONGVIENGKHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
4915 E BASELINE RD STE 115, GILBERT, AZ 85234-2966
(480) 279-4400
Mailing address
4915 E BASELINE RD STE 115, GILBERT, AZ 85234-2966
(480) 279-4400
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT-002670
AZ
Other
Enumeration date
01/10/2022
Last updated
02/27/2025
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