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General NPI Number Information
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NPI Number | 1114115037
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Entity Type | Organization
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Legal Business Name | BLAKE H. HORIO, M.D., LTD
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Dates
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Enumeration Date | 10/04/2007
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Last Update Date | 07/11/2008
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Provider Practice Location Address
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Address Line | 710 N YORK RD
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City | HINSDALE
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State | IL
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Zip | 60521-3555
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Country | US
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Telephone | 630-734-2000
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Fax | 630-734-1090
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Provider Business Mailing Address
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Address Line | PO BOX 643
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City | HINSDALE
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State | IL
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Zip | 60522-0643
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Country | US
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Telephone | 630-734-2000
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Fax | 630-734-1090
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. BLAKE H HORIO
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Credential | M.D.
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Telephone | 630-734-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 036-090898
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License Number State | IL
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