Provider Demographics
NPI:1578595336
Name:THALLEMER, JOSEPH MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:THALLEMER
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 1:3301 E CENTER STREET EXT
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46582-3909
Mailing Address - Country:US
Mailing Address - Phone:574-269-3828
Mailing Address - Fax:574-269-3848
Practice Address - Street 1:3301 E CENTER STREET EXT
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:IN
Practice Address - Zip Code:46582-3909
Practice Address - Country:US
Practice Address - Phone:574-269-3828
Practice Address - Fax:574-269-3848
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18001892A152W00000X, 152WC0802X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100157080AMedicaid
IN190840AMedicare ID - Type Unspecified
IN5020720001Medicare NSC
INT34829Medicare UPIN