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General NPI Number Information
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NPI Number | 1043462914
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Entity Type | Organization
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Legal Business Name | BLAHNIK EYE CARE INC
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Dates
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Enumeration Date | 10/22/2008
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Last Update Date | 03/05/2010
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Provider Practice Location Address
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Address Line | 3740 S RIDGEWOOD AVE UNIT 103
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City | PORT ORANGE
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State | FL
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Zip | 32129-3510
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Country | US
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Telephone | 386-492-6999
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Fax | 386-492-6900
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Provider Business Mailing Address
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Address Line | 3740 S RIDGEWOOD AVE UNIT 103
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City | PORT ORANGE
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State | FL
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Zip | 32129-3510
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Country | US
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Telephone | 386-492-6999
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Fax | 386-492-6900
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SUZETTE A BLAHNIK
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Credential | O.D.
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Telephone | 386-492-6999
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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 | OPC2215
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License Number State | FL
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