NPI 1750074621 · live from the CMS NPI Registry
Tyler Ray Bellack, OD
Optometrist in Kennesaw, GA. National Provider Identifier 1750074621, active.
NPI record
| NPI | 1750074621 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Optometrist 152W00000X |
| Practice location | 400 Ernest W Barrett Pkwy Nw Ste 617, Kennesaw, GA 30144 |
| Practice phone | 772-272-9470 |
| Mailing address | 3338 Littleport Ln Nw, Acworth, GA 30101 |
| Enumerated | May 29, 2023 |
| Last updated | July 3, 2023 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | — |
| Optometrist primary | 152W00000X | OPT003500 (GA) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.