Individual
DR. TYLER RAY BELLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
400 ERNEST W BARRETT PKWY NW STE 617, KENNESAW, GA 30144-4997
(772) 272-9470
Mailing address
3338 LITTLEPORT LN NW, ACWORTH, GA 30101-6972
(770) 259-9530
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT003500
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
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Other
Enumeration date
05/29/2023
Last updated
07/03/2023
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