Provider Demographics
NPI:1063409019
Name:MAULE, TAMARA LEE (OD)
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:LEE
Last Name:MAULE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8903 GLADES RD
Mailing Address - Street 2:BAY A 1
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-4074
Mailing Address - Country:US
Mailing Address - Phone:561-477-3524
Mailing Address - Fax:561-477-3576
Practice Address - Street 1:8903 GLADES RD
Practice Address - Street 2:BAY A 1
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-4074
Practice Address - Country:US
Practice Address - Phone:561-477-3524
Practice Address - Fax:561-477-3576
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-04
Last Update Date:2011-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2450152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOPC2450OtherFLORIDA LICENSE
U13809Medicare UPIN
FL20245Medicare PIN