Healthcare Provider Details

I. General information

NPI: 1245308253
Provider Name (Legal Business Name): BRANDON A. BLAIR, O.D., P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 02/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 M ST
ORD NE
68862-1428
US

IV. Provider business mailing address

1511 M ST
ORD NE
68862-1428
US

V. Phone/Fax

Practice location:
  • Phone: 308-729-3229
  • Fax: 308-728-5908
Mailing address:
  • Phone: 308-729-3229
  • Fax: 308-728-5908

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: BRANDON A. BLAIR
Title or Position: OWNER
Credential: OD
Phone: 308-728-3229