Provider Demographics
NPI:1912047937
Name:GARRAL TIADEN, O.D.
Entity Type:Organization
Organization Name:GARRAL TIADEN, O.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARRAL
Authorized Official - Middle Name:
Authorized Official - Last Name:TIADEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:979-836-3597
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
Mailing Address - Country:US
Mailing Address - Phone:979-836-3597
Mailing Address - Fax:979-277-0239
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:979-277-0239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX2893152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE31KOtherBLUE CROSS AND BLUE SHIEL
TX0895720001Medicare ID - Type Unspecified