Provider Demographics
NPI:1730284050
Name:TIEDE, CHAD NATHANIEL (OD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:NATHANIEL
Last Name:TIEDE
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:825 FIFTH AVENUE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CHAMBERSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17201-4214
Mailing Address - Country:US
Mailing Address - Phone:717-262-9700
Mailing Address - Fax:717-262-9714
Practice Address - Street 1:825 FIFTH AVENUE
Practice Address - Street 2:SUITE 102
Practice Address - City:CHAMBERSBURG
Practice Address - State:PA
Practice Address - Zip Code:17201
Practice Address - Country:US
Practice Address - Phone:717-262-9700
Practice Address - Fax:717-262-9714
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOEG001727152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist