MEDICARE: DR. GREGORY R. BOSCHERT, OPTOMETRIST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	T02220	MO

General Provider Information

NPI Number	:	1043385875
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. GREGORY R. BOSCHERT, OPTOMETRIST

Provider Business Mailing Address
First Line	:	5223 S GRAND BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63111-1616
Country	:	US
Telephone Number	:	314-352-7766
Fax Number	:

Provider Business Practice Location Address
First Line	:	5223 S GRAND BLVD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63111-1616
Country	:	US
Telephone Number	:	314-352-7766
Fax Number	:

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. GREGORY RANDOLPH BOSCHERT
Credential	:	O.D.
Telephone Number	:	314-352-7766

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	08/22/2020

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