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General NPI Number Information
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NPI Number | 1043385875
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Entity Type | Organization
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Legal Business Name | DR. GREGORY R. BOSCHERT, OPTOMETRIST
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5223 S GRAND BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63111-1616
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Country | US
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Telephone | 314-352-7766
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Fax |
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Provider Business Mailing Address
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Address Line | 5223 S GRAND BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63111-1616
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Country | US
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Telephone | 314-352-7766
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. GREGORY RANDOLPH BOSCHERT
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Credential | O.D.
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Telephone | 314-352-7766
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | T02220
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License Number State | MO
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