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General NPI Number Information
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NPI Number | 1487726568
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Entity Type | Individual
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Provider Name | SHELLY BLAKER O.D.
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Gender | Female
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Dates
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Enumeration Date | 11/14/2006
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Last Update Date | 04/11/2011
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Provider Practice Location Address
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Address Line | 508 S. ADAMS
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City | FREDERICKSBURG
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State | TX
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Zip | 78624-4472
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Country | US
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Telephone | 830-997-2504
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Fax | 830-997-5155
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Provider Business Mailing Address
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Address Line | 508 S. ADAMS
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City | FREDERICKSBURG
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State | TX
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Zip | 78624-4472
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Country | US
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Telephone | 830-997-2504
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Fax | 830-997-5155
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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 | 6569TG
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License Number State | TX
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