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General NPI Number Information
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NPI Number | 1043265267
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Entity Type | Individual
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Provider Name | JULIE M BLENKER O.D.
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Gender | Female
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Dates
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Enumeration Date | 05/24/2006
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Last Update Date | 03/25/2023
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Provider Practice Location Address
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Address Line | 261 RUTH ST N STE E
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City | SAINT PAUL
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State | MN
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Zip | 55119-4337
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Country | US
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Telephone | 651-739-5173
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Fax | 651-739-8907
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Provider Business Mailing Address
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Address Line | 7244 CRANE DR
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City | LINO LAKES
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State | MN
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Zip | 55038-4701
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Country | US
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Telephone | 763-292-0101
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Fax | 651-788-9695
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2652-035
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 2573
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License Number State | MN
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