NPIMap

Organization Active NPI

Dr Tabitha G Temple PC

  • Optometrist
  • Warsaw, IN
National Provider Identifier
1851484125
Registry record updated Jul 3, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
18002882 Issued in IN
Legal business name
DR TABITHA G TEMPLE PC
Practice address
3505 N State Road 15
Suite B
Warsaw, IN 46582-5503
Phone
(574) 267-3515
Fax
(574) 267-3259
NPI assigned
Oct 1, 2006
Last updated
Jul 3, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 3, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Tabitha G. Temple, O.D.NPI 1710971924
Title
Owner President
Phone
(574) 267-3515

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X 18002882 IN Primary

Addresses

Primary practice location

3505 N State Road 15
Suite B
Warsaw, IN 46582-5503

Mailing address

3505 N State Road 15
Suite B
Warsaw, IN 46582-5503
Phone (574) 267-3515

Other identifiers 1

IdentifierTypeStateIssuer
200388760AMedicaidIN

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20100930039668 IN DME Supplier - Physician - OptometristDME Supplier - Optician 2365442738 Practice locations: Warsaw, IN

National Provider Directory

National Provider Directory

Locations

2250 N Pointe Dr
Warsaw, IN 46582
Phone (574) 267-3515

2250 N Pointe Dr
Ste A
Warsaw, IN 46582
Phone (574) 267-3515

3505 N State Road 15
Ste B
Warsaw, IN 46582
Phone (574) 267-2906

Practitioners & affiliated clinicians

Practitioners 32

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 32

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159660800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1215043200000",
    "number": "1851484125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3505 N STATE ROAD 15",
            "address_2": "SUITE B",
            "city": "WARSAW",
            "state": "IN",
            "postal_code": "465825503",
            "telephone_number": "574-267-3515",
            "fax_number": "574-267-3259"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3505 N STATE ROAD 15",
            "address_2": "SUITE B",
            "city": "WARSAW",
            "state": "IN",
            "postal_code": "465825503",
            "telephone_number": "574-267-3515",
            "fax_number": "574-267-3259"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR TABITHA G TEMPLE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-01",
        "last_updated": "2008-07-03",
        "status": "A",
        "authorized_official_last_name": "TEMPLE",
        "authorized_official_first_name": "TABITHA",
        "authorized_official_middle_name": "G.",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "574-267-3515",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "IN",
            "license": "18002882",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200388760A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Warsaw, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.