Provider Demographics
NPI:1578062410
Name:TARA A THIEL OD PA
Entity Type:Organization
Organization Name:TARA A THIEL OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TARA
Authorized Official - Middle Name:A
Authorized Official - Last Name:THIEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:727-302-0467
Mailing Address - Street 1:2031 8TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-3246
Mailing Address - Country:US
Mailing Address - Phone:727-302-0467
Mailing Address - Fax:727-302-0498
Practice Address - Street 1:6901 22ND AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-3943
Practice Address - Country:US
Practice Address - Phone:727-302-0467
Practice Address - Fax:727-302-0498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-06
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty