Provider Demographics
NPI:1265587034
Name:JOSEPH M. THALLEMER, O.D., P.C.
Entity type:Organization
Organization Name:JOSEPH M. THALLEMER, O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:THALLEMER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:574-269-3828
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2009-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200372990Medicaid
IN200372990Medicaid
INDB4127Medicare PIN
INT34829Medicare UPIN
IN5020720001Medicare NSC