Provider Demographics
NPI:1396757464
Name:BOSCHERT, JANET BOSCHERT (OD)
Entity type:Individual
Prefix:MISS
First Name:JANET
Middle Name:BOSCHERT
Last Name:BOSCHERT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:JANET
Other - Middle Name:MARIE
Other - Last Name:BOSCHERT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:5500 E. KELLOGG
Mailing Address - Street 2:SPECIALTY CARE (11-SC)
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218
Mailing Address - Country:US
Mailing Address - Phone:816-838-9929
Mailing Address - Fax:
Practice Address - Street 1:5500 E. KELLOGG
Practice Address - Street 2:SPECIALTY CARE (11-SC)
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218
Practice Address - Country:US
Practice Address - Phone:816-838-9929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005029516152W00000X
KS1727152W00000X
OK2511152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist