MEDICARE: DR. JOHN D BOER O.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	152W00000X	Optometrist	637	SD

General Provider Information

NPI Number	:	1225234453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN D BOER O.D.

Provider Business Mailing Address
First Line	:	108 EMMETT TRAIL
Second Line	:
City	:	HARRISBURG
State	:	SD
Zip	:	57032
Country	:	US
Telephone Number	:	605-213-2020
Fax Number	:

Provider Business Practice Location Address
First Line	:	220 S CLIFF AVE STE 102
Second Line	:
City	:	HARRISBURG
State	:	SD
Zip	:	57032-2117
Country	:	US
Telephone Number	:	605-213-2020
Fax Number	:

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

Provider Enumeration Date	:	06/25/2007
Last Update Date	:	07/13/2009

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Directions to “ DR. JOHN D BOER O.D.” Practice Location

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