Provider Demographics
NPI:1710260427
Name:TAMARA L. MAULE, O.D., P.A.
Entity Type:Organization
Organization Name:TAMARA L. MAULE, O.D., P.A.
Other - Org Name:DR. MAULE AND ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIC PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MAULE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:561-477-3524
Mailing Address - Street 1:8903 GLADES RD
Mailing Address - Street 2:BAY A1
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-4074
Mailing Address - Country:US
Mailing Address - Phone:561-477-3524
Mailing Address - Fax:561-477-3576
Practice Address - Street 1:8903 GLADES RD
Practice Address - Street 2:BAY A1
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-4074
Practice Address - Country:US
Practice Address - Phone:561-477-3524
Practice Address - Fax:561-477-3576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-20
Last Update Date:2012-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 2450152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGL555AMedicare PIN