Provider Demographics
NPI:1831445386
Name:TIADEN, GARRAL JOHN (OD)
Entity type:Individual
Prefix:
First Name:GARRAL
Middle Name:JOHN
Last Name:TIADEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2448 BECKER DR STE 200
Mailing Address - Street 2:
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-5714
Mailing Address - Country:US
Mailing Address - Phone:979-836-3597
Mailing Address - Fax:
Practice Address - Street 1:2448 BECKER DR STE 200
Practice Address - Street 2:
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-5714
Practice Address - Country:US
Practice Address - Phone:979-836-3597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-01
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2893152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist