Provider Demographics
NPI:1336308089
Name:THOMAS G JUHL OD
Entity Type:Organization
Organization Name:THOMAS G JUHL OD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:JUHL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:641-664-2324
Mailing Address - Street 1:505 W JEFFERSON ST
Mailing Address - Street 2:PO BOX 319
Mailing Address - City:BLOOMFIELD
Mailing Address - State:IA
Mailing Address - Zip Code:52537-1515
Mailing Address - Country:US
Mailing Address - Phone:641-664-2325
Mailing Address - Fax:641-664-3433
Practice Address - Street 1:505 W JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:IA
Practice Address - Zip Code:52537-1515
Practice Address - Country:US
Practice Address - Phone:641-664-2325
Practice Address - Fax:641-664-3433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-07
Last Update Date:2008-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1621332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0165845Medicaid
IA0165845Medicaid
IA0485420001Medicare NSC
IA16584Medicare PIN