Healthcare Provider Details

I. General information

NPI: 1417169681
Provider Name (Legal Business Name): TEMMEN ADVANCED EYE CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 W MAIN
MT ZION IL
62549
US

IV. Provider business mailing address

1505 W MAIN
MT ZION IL
62549
US

V. Phone/Fax

Practice location:
  • Phone: 217-864-3221
  • Fax: 217-864-3345
Mailing address:
  • Phone: 217-864-3221
  • Fax: 217-864-3345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number046008630
License Number StateIL

VIII. Authorized Official

Name: CAMDA M TEMMEN
Title or Position: OWNER
Credential: OD
Phone: 217-864-3221