Healthcare Provider Details

I. General information

NPI: 1265587034
Provider Name (Legal Business Name): JOSEPH M. THALLEMER, O.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 09/03/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 E CENTER STREET EXT
WARSAW IN
46582-3909
US

IV. Provider business mailing address

3301 E CENTER STREET EXT
WARSAW IN
46582-3909
US

V. Phone/Fax

Practice location:
  • Phone: 574-269-3828
  • Fax: 574-269-3848
Mailing address:
  • Phone: 574-269-3828
  • Fax: 574-269-3848

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. JOSEPH MICHAEL THALLEMER
Title or Position: OWNER
Credential: O.D.
Phone: 574-269-3828