Healthcare Provider Details

I. General information

NPI: 1508217332
Provider Name (Legal Business Name): BLENKER EYE CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2016
Last Update Date: 03/25/2023
Certification Date: 03/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

261 RUTH ST N STE E
SAINT PAUL MN
55119-4337
US

IV. Provider business mailing address

7244 CRANE DR
LINO LAKES MN
55038-4701
US

V. Phone/Fax

Practice location:
  • Phone: 651-739-5173
  • Fax: 651-739-8907
Mailing address:
  • Phone: 763-292-0101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2573
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code332H00000X
TaxonomyEyewear Supplier
License Number
License Number State

VIII. Authorized Official

Name: JULIE M BLENKER
Title or Position: OWNER
Credential:
Phone: 763-292-0101