Provider Demographics
NPI:1922440387
Name:GRAHAM, TAMMI (OD)
Entity Type:Individual
Prefix:DR
First Name:TAMMI
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MISS
Other - First Name:TAMMI
Other - Middle Name:
Other - Last Name:HA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:25327 HAWTHORNE BLOSSOM DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77389-4295
Mailing Address - Country:US
Mailing Address - Phone:408-966-3772
Mailing Address - Fax:
Practice Address - Street 1:10700 KUYKENDAHL RD STE J
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-2404
Practice Address - Country:US
Practice Address - Phone:832-585-1300
Practice Address - Fax:832-585-1309
Is Sole Proprietor?:No
Enumeration Date:2013-07-25
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX8277TG152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112409104Medicaid
1043951189OtherGROUP NPI
TX112409104Medicaid