MEDICARE: DR. SHERYL L BLANKENSHIP OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	1773AT	OR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255324158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHERYL L BLANKENSHIP OD

Provider Business Mailing Address
First Line	:	18481 W CAMPBELL LOOP
Second Line	:
City	:	BAKER CITY
State	:	OR
Zip	:	97814-8412
Country	:	US
Telephone Number	:	541-523-9358
Fax Number	:

Provider Business Practice Location Address
First Line	:	2150 3RD ST
Second Line	:
City	:	BAKER CITY
State	:	OR
Zip	:	97814-2609
Country	:	US
Telephone Number	:	541-523-5858
Fax Number	:	541-523-7652

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	03/07/2023

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