=====================================================
General NPI Number Information
=====================================================
NPI Number | 1841538733
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | J.M. TEMPEL O.D. P.C.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/28/2013
-----------------------------------------------------
Last Update Date | 01/28/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1952 PLYMOUTH AVE
-----------------------------------------------------
City | WATERLOO
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50702-3524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-236-9600
-----------------------------------------------------
Fax | 319-236-0605
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1952 PLYMOUTH AVE
-----------------------------------------------------
City | WATERLOO
-----------------------------------------------------
State | IA
-----------------------------------------------------
Zip | 50702-3524
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 319-236-9600
-----------------------------------------------------
Fax | 319-236-0605
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. JEROME MARTIN TEMPLE
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 319-236-9600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 01681
-----------------------------------------------------
License Number State | IA
-----------------------------------------------------