Provider Demographics
NPI:1235318106
Name:TEMPLETON, TERENCE GRAIL (OD)
Entity Type:Individual
Prefix:DR
First Name:TERENCE
Middle Name:GRAIL
Last Name:TEMPLETON
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 1:1206 HULL RD
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-6061
Mailing Address - Country:US
Mailing Address - Phone:419-625-6300
Mailing Address - Fax:419-625-8901
Practice Address - Street 1:1206 HULL RD
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-6061
Practice Address - Country:US
Practice Address - Phone:419-625-6300
Practice Address - Fax:419-625-8901
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-29
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3390152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000330580OtherANTHEM BLUE VISION
OH0820550001OtherADMINISTAR
OH0503021OtherMEDICARE
1036600OtherAETNA MEDICARE
04715OtherPARAMOUNT HEALTH CARE
791580728OtherUNITED HEALTHCARE
OH791580728OtherRAILROAD MEDICARE
122705OtherWAUSAU BENEFITS
OH000000330580OtherANTHEM BCBS
000000330580OtherBLUE CROSS BLUE SHIELD
OH791580728Medicare PIN
000000330580OtherANTHEM BLUE VISION
791580728OtherUNITED HEALTHCARE
122705OtherWAUSAU BENEFITS
OH1036600Medicare UPIN