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General NPI Number Information
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NPI Number | 1841326584
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Entity Type | Individual
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Provider Name | JOHN BOCKHAUS O. D.
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Gender | Male
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Dates
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Enumeration Date | 02/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1510 125TH AVE NE
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City | BLAINE
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State | MN
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Zip | 55449-4749
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Country | US
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Telephone | 763-755-9380
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Fax |
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Provider Business Mailing Address
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Address Line | 5201 SUMTER AVE N
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City | NEW HOPE
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State | MN
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Zip | 55428-4226
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Country | US
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Telephone |
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Fax |
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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 | 1593
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License Number State | MN
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