Provider Demographics
NPI:1700517828
Name:ESCOBAR EGUIZABAL, TANIA GABRIELA (OD)
Entity Type:Individual
Prefix:
First Name:TANIA
Middle Name:GABRIELA
Last Name:ESCOBAR EGUIZABAL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:839 N NOLAN RIVER RD
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-7001
Mailing Address - Country:US
Mailing Address - Phone:817-645-2411
Mailing Address - Fax:817-645-3447
Practice Address - Street 1:839 N NOLAN RIVER RD
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-7001
Practice Address - Country:US
Practice Address - Phone:817-645-2411
Practice Address - Fax:817-645-3447
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10666152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist