Individual
DANIEL SCOTT TIEDEMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
9394 BIG HORN BLVD, ELK GROVE, CA 95758-7977
(916) 691-8500
(916) 691-8589
Mailing address
3400 DATA DR, RANCHO CORDOVA, CA 95670-7956
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
12657
CA
Other
Enumeration date
03/30/2007
Last updated
12/08/2023
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