Individual
TYLER J. ETHERIDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
12403679-1205
UT
207W00000X
Ophthalmology Physician
83222-20
WI
207W00000X
Ophthalmology Physician
Primary
MD229341
OR
Other
Enumeration date
03/31/2020
Last updated
07/02/2026
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