Individual
DR. TYLER WILLIAM ELLSWORTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
8075 MALL PKWY STE 103, LITHONIA, GA 30038-6993
(770) 484-2955
Mailing address
8075 MALL PKWY STE 103, LITHONIA, GA 30038-6993
(770) 484-2955
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OPT003180
GA
Other
Enumeration date
07/15/2019
Last updated
07/15/2019
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