Basic Information
| Provider Information | |||||||||
| NPI: | 1952308678 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BOHN | ||||||||
| FirstName: | JEFFREY | ||||||||
| MiddleName: | L | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 846098 | ||||||||
| Address2: | |||||||||
| City: | DALLAS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 752846098 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9033246400 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1424 EAST FRONT | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757028501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035954144 | ||||||||
| FaxNumber: | 9035967541 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/07/2005 | ||||||||
| LastUpdateDate: | 11/06/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | K1781 | TX | Y | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 5220532 | 01 | TX | AETNA | OTHER | 89V981 | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 129098306 | 05 | TX | MEDICAID | 129098304 | 05 | TX | MEDICAID | 1477891 | 01 | TX | UNITED HEALTHCARE | OTHER | P02098854 | 01 | TX | MEDICARE RAIL ROAD | OTHER | 704966 | 01 | TX | MEDICARE | OTHER | 2061748 | 01 | TX | CIGNA | OTHER | 609159 | 01 | TX | FIRST HEALTH | OTHER |