MEDICARE: JENNA BLECHMAN BLATT O.D.

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	OPC5226	FL
2	152W00000X	Optometrist	TUV008666	NY
3	152W00000X	Optometrist	10189TG	TX

General Provider Information

NPI Number	:	1700234754
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNA BLECHMAN BLATT O.D.

Provider Business Mailing Address
First Line	:	1116 NE 117TH ST
Second Line	:
City	:	BISCAYNE PARK
State	:	FL
Zip	:	33161-6752
Country	:	US
Telephone Number	:	561-702-1899
Fax Number	:

Provider Business Practice Location Address
First Line	:	3015 GRAND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33133-5144
Country	:	US
Telephone Number	:	786-216-7850
Fax Number	:

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

Provider Enumeration Date	:	06/01/2016
Last Update Date	:	10/23/2023

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