MEDICARE: CHRISTOPHER FREDERICK BLODI MD

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	207WX0107X	Retina Specialist (Ophthalmology) Physician	23468	IA
2	207W00000X	Ophthalmology Physician	31257	NE

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	:	1689642290
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTOPHER FREDERICK BLODI MD

Provider Business Mailing Address
First Line	:	988102 NEBRASKA MEDICAL CTR
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68198-8102
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3902 LEAVENWORTH ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68105-1119
Country	:	US
Telephone Number	:	402-559-2020
Fax Number	:	402-559-2267

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

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	02/03/2019

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