Provider Demographics
NPI:1841538733
Name:J.M. TEMPEL O.D. P.C.
Entity type:Organization
Organization Name:J.M. TEMPEL O.D. P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:TEMPLE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:319-236-9600
Mailing Address - Street 1:1952 PLYMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:WATERLOO
Mailing Address - State:IA
Mailing Address - Zip Code:50702-3524
Mailing Address - Country:US
Mailing Address - Phone:319-236-9600
Mailing Address - Fax:319-236-0605
Practice Address - Street 1:1952 PLYMOUTH AVE
Practice Address - Street 2:
Practice Address - City:WATERLOO
Practice Address - State:IA
Practice Address - Zip Code:50702-3524
Practice Address - Country:US
Practice Address - Phone:319-236-9600
Practice Address - Fax:319-236-0605
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01681152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0161679IAMedicaid
IA0161679IAMedicaid