Provider Demographics
NPI:1194806034
Name:BOCHNER, DIRK J (OD)
Entity type:Individual
Prefix:
First Name:DIRK
Middle Name:J
Last Name:BOCHNER
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:223 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-1208
Mailing Address - Country:US
Mailing Address - Phone:812-882-4809
Mailing Address - Fax:812-882-9485
Practice Address - Street 1:223 MAIN ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1208
Practice Address - Country:US
Practice Address - Phone:812-882-4809
Practice Address - Fax:812-882-9485
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046-009920152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0814870005OtherMEDICARE NSC NUMBER
124046OtherHEALTH ALLIANCE
IL0814870001OtherMEDICARE NSC NUMBER
IL081470009OtherMEDICARE NSC NUMBER
IL0814870019OtherMEDICARE NSC NUMBER
IL0814870003OtherMEDICARE NSC NUMBER
ILP00434353OtherMEDICARE RAILROAD
IN3220OtherEYEMED
IL046009920Medicaid
413010OtherHARMONY HEALTH PLAN
IL0814870019OtherMEDICARE NSC NUMBER
IL0814870003OtherMEDICARE NSC NUMBER