Provider Demographics
NPI:1568454379
Name:SEMLER-BLUE, CHRISTINE L (OD)
Entity Type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:L
Last Name:SEMLER-BLUE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALLTOWN
Mailing Address - State:IA
Mailing Address - Zip Code:50158-2946
Mailing Address - Country:US
Mailing Address - Phone:641-754-6200
Mailing Address - Fax:
Practice Address - Street 1:619 BROAD ST
Practice Address - Street 2:
Practice Address - City:STORY CITY
Practice Address - State:IA
Practice Address - Zip Code:50248-1200
Practice Address - Country:US
Practice Address - Phone:641-754-6200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02173152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA2211045Medicaid
IAP00154323OtherRAILROAD MEDICARE
IAU80869Medicare UPIN
IAI12801Medicare PIN