Provider Demographics
NPI:1568442234
Name:TEMPLIN, JEAN (OD)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:
Last Name:TEMPLIN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:
Other - Last Name:RIBERDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:11 E LINDEN ST
Mailing Address - Street 2:PO BOX 156
Mailing Address - City:RICHLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17087-9752
Mailing Address - Country:US
Mailing Address - Phone:717-866-2030
Mailing Address - Fax:717-866-2818
Practice Address - Street 1:5 E LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:MYERSTOWN
Practice Address - State:PA
Practice Address - Zip Code:17067-1108
Practice Address - Country:US
Practice Address - Phone:717-866-2030
Practice Address - Fax:717-866-2818
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOE0007342T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA7261072Medicaid
PAU53059Medicare UPIN
PA7261072Medicaid