MEDICARE: DR. JAMES EDWARD BUCHLI OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1666	MN
2	152W00000X	Optometrist	OPT001629	GA
3	152W00000X	Optometrist		IL

General Provider Information

NPI Number	:	1740257278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES EDWARD BUCHLI OD

Provider Business Mailing Address
First Line	:	4238 ALDEN DRIVE
Second Line	:
City	:	EDINA
State	:	MN
Zip	:	55416
Country	:	US
Telephone Number	:	952-926-7585
Fax Number	:

Provider Business Practice Location Address
First Line	:	844 GRAND AVE
Second Line	:
City	:	ST PAUL
State	:	MN
Zip	:	55105
Country	:	US
Telephone Number	:	651-291-5150
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/03/2006
Last Update Date	:	07/08/2007

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