Individual
JOHN BOCKHAUS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O. D.
Contact information
Practice address
1510 125TH AVE NE, BLAINE, MN 55449-4749
(763) 755-9380
Mailing address
5201 SUMTER AVE N, NEW HOPE, MN 55428-4226
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1593
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22-11395
MEDICA
MN
Enumeration date
02/26/2007
Last updated
07/08/2007
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