Provider Demographics
NPI:1487209060
Name:GIROUARD, TYLA LOUISE (OD, LDO)
Entity Type:Individual
Prefix:DR
First Name:TYLA
Middle Name:LOUISE
Last Name:GIROUARD
Suffix:
Gender:F
Credentials:OD, LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 LINCOLN SQ
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01608-1135
Mailing Address - Country:US
Mailing Address - Phone:508-373-5830
Mailing Address - Fax:617-395-2620
Practice Address - Street 1:10 LINCOLN SQ
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01608-1135
Practice Address - Country:US
Practice Address - Phone:508-373-5802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA390200000X
MA5383152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110155932AMedicaid