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General NPI Number Information
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NPI Number | 1477540433
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Entity Type | Individual
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Provider Name | JEFFREY DAVID BOEHME O.D.
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Gender | Male
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Dates
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Enumeration Date | 10/04/2005
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Last Update Date | 11/15/2024
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Provider Practice Location Address
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Address Line | 6305 LIBRARY RD
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City | SOUTH PARK
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State | PA
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Zip | 15129-8502
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Country | US
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Telephone | 412-854-4130
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Fax | 412-854-8175
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Provider Business Mailing Address
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Address Line | 418 HAYS RD
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City | VENETIA
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State | PA
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Zip | 15367-1001
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Country | US
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Telephone | 724-941-3404
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Fax | 412-655-6513
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | OEG000653
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License Number State | PA
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