Healthcare Provider Details

I. General information

NPI: 1851492201
Provider Name (Legal Business Name): CHRISTINE Y BLICK OD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

502 CELEBRATION AVE
CELEBRATION FL
34747-4687
US

IV. Provider business mailing address

502 CELEBRATION AVE
CELEBRATION FL
34747-4687
US

V. Phone/Fax

Practice location:
  • Phone: 407-566-8585
  • Fax: 407-566-8253
Mailing address:
  • Phone: 407-588-8505
  • Fax: 407-566-8253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINE Y BLICK
Title or Position: OPTOMETRIST
Credential: OD
Phone: 407-566-8505