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DR. TYLOR PRAVONGVIENGKHAM OD
NPI 1235880493
Optometrist in Gilbert, AZ

Active since January 10, 2022PECOS EnrolledAccepts Medicare Assignment
4915 E BASELINE RD STE 115, GILBERT, AZ 85234(480) 279-4400 Get Directions Write a Review

NPPES record last updated: February 27, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Feb 27, 2025, Dec 4, 2024, Feb 27, 2023 and 1 more (4 updates tracked since 2022).

About Dr. Tylor Pravongviengkham Od NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. TYLOR PRAVONGVIENGKHAM OD (NPI 1235880493) is an individual optometrist in Gilbert, Arizona, licensed in Arizona (OPT-002670) and active in the NPI registry since January 2022. He is enrolled in Medicare PECOS and is a graduate of Pennsylvania College Of Optometry (2021).

NPPES Registry Identity

NPI1235880493
Entity TypeIndividualMale
Primary Taxonomy152W00000X
Provider Legal NameDR. TYLOR PRAVONGVIENGKHAMCredential: OD
Location Address4915 E BASELINE RD STE 115Gilbert, AZ 85234-2966
Mailing Address4915 E Baseline Rd Ste 115Gilbert, AZ 85234-2966 · (480) 279-4400
Phone(480) 279-4400
Sole ProprietorNo
Medical School CMSPennsylvania College Of OptometryGraduated 2021
Enumeration DateJanuary 10, 2022
Last NPPES UpdateFebruary 27, 20254 updates tracked since enumeration
NPPES CertifiedFebruary 27, 2025
✔ NPI 1235880493 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOptometristEye and Vision Services Providers
Taxonomy Code152W00000X
License✔ Licensed in AZ · OPT-002670
Definition
Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.
4915 E BASELINE RD STE 115, Gilbert, AZ 85234
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arizona Complete Health, Blue Cross and Blue Shield of Louisiana, Blue Cross and Blue Shield of Montana and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Tylor Pravongviengkham Od is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID345614210
PECOS Enrollment IDI20230414002009
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
20 services15 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 85234 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$127.71 typical visit price
range $55.44 – $168.60
Typical copayment $31.92 (range $13.86 – $42.15)
Most-billed visit code 99204
Established Patient
$69.24 typical visit price
range $17.72 – $137.41
Typical copayment $17.31 (range $4.43 – $34.35)
Most-billed visit code 99213
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Tylor Pravongviengkham's NPI number?

The NPI number for Tylor Pravongviengkham is 1235880493. It was assigned to this individual provider in the NPPES registry on January 10, 2022.

Where is Tylor Pravongviengkham located?

Tylor Pravongviengkham practices at 4915 E Baseline Rd Ste 115, Gilbert, AZ 85234. The listed phone number is (480) 279-4400.

What is Tylor Pravongviengkham's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Is Tylor Pravongviengkham enrolled in Medicare?

Yes. Tylor Pravongviengkham is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Tylor Pravongviengkham accept?

Health plans from Ambetter from Arizona Complete Health, Blue Cross and Blue Shield of Louisiana, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and Blue Cross and Blue Shield of Texas and 1 other insurer list Tylor Pravongviengkham as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Tylor Pravongviengkham was last updated on February 27, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 17 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.