Individual
JACOB ANDREW BOEHME
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1245 MADISON AVE, MEMPHIS, TN 38104-2211
(901) 722-3200
Mailing address
1245 MADISON AVE, MEMPHIS, TN 38104-2211
(901) 722-3250
(901) 722-3388
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
114718
IA
152W00000X
Optometrist
3656
TN
152WP0200X
Pediatric Optometrist
114718
IA
152WP0200X
Pediatric Optometrist
Primary
3656
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
Q063630
—
TN
Enumeration date
11/05/2020
Last updated
12/31/2025
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