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General NPI Number Information
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NPI Number | 1336345560
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Entity Type | Organization
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Legal Business Name | JOHN BOER, PC
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Dates
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Enumeration Date | 06/25/2007
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Last Update Date | 12/20/2007
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Provider Practice Location Address
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Address Line | 1201 29TH ST SE STE A
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City | WATERTOWN
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State | SD
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Zip | 57201-9179
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Country | US
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Telephone | 605-886-0200
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Fax |
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Provider Business Mailing Address
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Address Line | 1313 E NORTHSTAR LN APT. 206
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City | SIOUX FALLS
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State | SD
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Zip | 57108-4811
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Country | US
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Telephone | 402-708-6680
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN D BOER
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Credential | O.D.
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Telephone | 402-708-6680
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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 | 637
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License Number State | SD
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