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General NPI Number Information
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NPI Number | 1417169681
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Entity Type | Organization
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Legal Business Name | TEMMEN ADVANCED EYE CARE LLC
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/13/2009
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Provider Practice Location Address
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Address Line | 1505 W MAIN
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City | MT ZION
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State | IL
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Zip | 62549
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Country | US
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Telephone | 217-864-3221
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Fax | 217-864-3345
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Provider Business Mailing Address
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Address Line | 1505 W MAIN
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City | MT ZION
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State | IL
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Zip | 62549
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Country | US
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Telephone | 217-864-3221
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Fax | 217-864-3345
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Authorized Official
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Title or Position | OWNER
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Name | CAMDA M TEMMEN
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Credential | OD
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Telephone | 217-864-3221
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 046008630
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License Number State | IL
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