Provider Demographics
NPI:1336339167
Name:GORMAN, TIFFANIE RENEE (OD)
Entity Type:Individual
Prefix:
First Name:TIFFANIE
Middle Name:RENEE
Last Name:GORMAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:TIFFANIE
Other - Middle Name:RENEE
Other - Last Name:CHILDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:3004 YALE ST STE 600
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77018-8438
Mailing Address - Country:US
Mailing Address - Phone:713-766-6650
Mailing Address - Fax:713-766-6772
Practice Address - Street 1:3004 YALE ST STE 600
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77018-8443
Practice Address - Country:US
Practice Address - Phone:713-410-7683
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-27
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7059TG152WC0802X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7059OtherTOB LICENSE
TX8F23945Medicare PIN