MEDICARE: DR. BLAIR EDWARD BOEHMER M.D.

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	207W00000X	Ophthalmology Physician	01069880A	IN

General Provider Information

NPI Number	:	1134313638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BLAIR EDWARD BOEHMER M.D.

Provider Business Mailing Address
First Line	:	421 CANAL VIEW CIR
Second Line	:	APT K
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-6141
Country	:	US
Telephone Number	:	317-844-6269
Fax Number	:	317-815-7567

Provider Business Practice Location Address
First Line	:	10610 N PENNSYLVANIA ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46280-2004
Country	:	US
Telephone Number	:	317-844-6269
Fax Number	:	317-815-7567

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

Provider Enumeration Date	:	08/29/2007
Last Update Date	:	09/16/2011

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