Healthcare Provider Details

I. General information

NPI: 1205814183
Provider Name (Legal Business Name): JEFFREY HEATH BLUNDEN O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

617 SCOON RD
SUNNYSIDE WA
98944-1031
US

IV. Provider business mailing address

PO BOX 2605
YAKIMA WA
98907-2605
US

V. Phone/Fax

Practice location:
  • Phone: 509-837-8200
  • Fax:
Mailing address:
  • Phone: 509-454-4143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5535-T
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3385
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: