Healthcare Provider Details

I. General information

NPI: 1003544511
Provider Name (Legal Business Name): JOHN PETER BLINK II OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2022
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3620 W 29TH AVE URBAN EYES VISION CARE
DENVER CO
80211
US

IV. Provider business mailing address

3620 W 29TH AVE
DENVER CO
80211
US

V. Phone/Fax

Practice location:
  • Phone: 303-433-5820
  • Fax: 303-433-5869
Mailing address:
  • Phone: 303-433-5820
  • Fax: 303-433-5869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT.0003834
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: