Richard Boehm
Individual provider Active NPI Eyewear Supplier · Ardmore, PA
NPI 1104049501 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1104049501
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Eyewear Supplier 332H00000X
- License
- NJ D-1242 (NJ)
- Practice address
- 17 E Lancaster Ave
Ardmore, PA 19003-2319 - Phone
- (610) 645-0546
- NPI assigned
- Apr 11, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| NJ D-1242 | NJ | MD | Eyewear Supplier |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Eyewear Supplier | 332H00000X | NJ D-1242 | NJ | Yes |
Addresses
Primary practice location
17 E Lancaster Ave
Ardmore, PA 19003-2319
Mailing address
17 E Lancaster Ave
Ardmore, PA 19003-2319
Other providers in Ardmore, PA
- Lucas Bernardo
- Eric Ferenc Bernstein
- Larysa K Bilyk
- Jenny Maricela Blaszczyk
- Bloom Healthcare Limited
- Bounce Back Physical Therapy Inc.
- Maureen Sandra Boyle Cieri
- Braids & Things LLC
- Andrea Braver
- Leah Brecher-Cohn
All providers in Ardmore, PA · Eyewear Supplier in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.