Healthcare Provider Details

I. General information

NPI: 1487631024
Provider Name (Legal Business Name): JESSE PETER BLATTSTEIN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/25/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

371 STATE ROUTE 17M SUITE 3
MONROE NY
10950-3434
US

IV. Provider business mailing address

21 ARLINGTON DR
HARRIMAN NY
10926-3810
US

V. Phone/Fax

Practice location:
  • Phone: 845-782-3937
  • Fax:
Mailing address:
  • Phone: 845-238-3441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberVUT005307
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberVUT005307
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberVUT005307
License Number StateNY
# 4
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License NumberVUT005307
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License NumberV
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: