Provider Demographics
NPI:1932283710
Name:TEMPLE OPTOMETRISTS, P.C.
Entity Type:Organization
Organization Name:TEMPLE OPTOMETRISTS, P.C.
Other - Org Name:TEXAS STATE OPTICAL
Other - Org Type:Other Name
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:ARDITH
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:PAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:254-778-6165
Mailing Address - Street 1:2910 MARKET LOOP
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-1855
Mailing Address - Country:US
Mailing Address - Phone:254-778-6165
Mailing Address - Fax:254-778-5257
Practice Address - Street 1:2910 MARKET LOOP
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-1855
Practice Address - Country:US
Practice Address - Phone:254-778-6165
Practice Address - Fax:254-778-5257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0931818-01Medicaid
TX0633210001Medicare NSC