Provider Demographics
NPI:1205408291
Name:TEMPLE, MICHAELA (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAELA
Middle Name:
Last Name:TEMPLE
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 1:738 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-2503
Mailing Address - Country:US
Mailing Address - Phone:781-329-5454
Mailing Address - Fax:781-329-7813
Practice Address - Street 1:738 HIGH ST
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-2503
Practice Address - Country:US
Practice Address - Phone:781-329-5454
Practice Address - Fax:781-329-7813
Is Sole Proprietor?:No
Enumeration Date:2021-07-11
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIODTG00722152W00000X
MA5519152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist