Healthcare Provider Details

I. General information

NPI: 1568454379
Provider Name (Legal Business Name): CHRISTINE L. SEMLER-BLUE O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 02/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

619 BROAD ST
STORY CITY IA
50248-1200
US

IV. Provider business mailing address

309 E CHURCH ST
MARSHALLTOWN IA
50158-2946
US

V. Phone/Fax

Practice location:
  • Phone: 641-754-6200
  • Fax:
Mailing address:
  • Phone: 641-754-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number02173
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: