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General NPI Number Information
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NPI Number | 1205814183
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Entity Type | Individual
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Provider Name | JEFFREY HEATH BLUNDEN O.D.
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Gender | Male
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Dates
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Enumeration Date | 01/03/2006
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Last Update Date | 09/23/2020
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Provider Practice Location Address
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Address Line | 617 SCOON RD
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City | SUNNYSIDE
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State | WA
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Zip | 98944-1031
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Country | US
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Telephone | 509-837-8200
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2605
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City | YAKIMA
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State | WA
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Zip | 98907-2605
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Country | US
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Telephone | 509-454-4143
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Fax |
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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 | 5535-T
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License Number State | TX
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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 | 3385
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License Number State | WA
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