Provider Demographics
NPI:1225445158
Name:PAGE, GLADDIS THOMAS (OD)
Entity Type:Individual
Prefix:
First Name:GLADDIS
Middle Name:THOMAS
Last Name:PAGE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:GLADDIS
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1326 YAUPON LOOP
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-2973
Mailing Address - Country:US
Mailing Address - Phone:614-599-5120
Mailing Address - Fax:
Practice Address - Street 1:312 FM 306
Practice Address - Street 2:STE 110
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-2556
Practice Address - Country:US
Practice Address - Phone:210-845-0383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2019-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8505T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist