MEDICARE: DR. RICHARD BOHN OD

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	TUV002830-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124163647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD BOHN OD

Provider Business Mailing Address
First Line	:	3450 LONG BEACH RD
Second Line	:
City	:	OCEANSIDE
State	:	NY
Zip	:	11572-5440
Country	:	US
Telephone Number	:	516-678-1616
Fax Number	:	516-764-2711

Provider Business Practice Location Address
First Line	:	3450 LONG BEACH RD
Second Line	:
City	:	OCEANSIDE
State	:	NY
Zip	:	11572-5440
Country	:	US
Telephone Number	:	516-678-1616
Fax Number	:	516-764-2711

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	05/28/2009

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