Provider Demographics
NPI:1144725268
Name:MATHIESON, TIANA JEAN (OD)
Entity type:Individual
Prefix:
First Name:TIANA
Middle Name:JEAN
Last Name:MATHIESON
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 1:1560 MALL DR
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23511-3806
Mailing Address - Country:US
Mailing Address - Phone:757-440-1075
Mailing Address - Fax:619-764-4022
Practice Address - Street 1:1560 MALL DR
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23511-3806
Practice Address - Country:US
Practice Address - Phone:757-440-1075
Practice Address - Fax:619-764-4022
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3080152W00000X
CAOPT34109-TLG152W00000X
ALR-312-TA-C54152W00000X
VA0618003436152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist