Provider Demographics
NPI:1750517348
Name:BAILEY, TARA BROOKE (OD)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:BROOKE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12007 SCHMIDT RD
Mailing Address - Street 2:
Mailing Address - City:WALLER
Mailing Address - State:TX
Mailing Address - Zip Code:77484-5060
Mailing Address - Country:US
Mailing Address - Phone:281-757-4030
Mailing Address - Fax:
Practice Address - Street 1:12007 SCHMIDT RD
Practice Address - Street 2:
Practice Address - City:WALLER
Practice Address - State:TX
Practice Address - Zip Code:77484-5060
Practice Address - Country:US
Practice Address - Phone:281-757-4030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-09
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7454T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB114483Medicare PIN