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General NPI Number Information
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NPI Number | 1538340419
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Entity Type | Organization
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Legal Business Name | BLINK OPTICAL BOUTIQUE,LLC
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Dates
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Enumeration Date | 11/19/2007
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Last Update Date | 04/17/2008
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Provider Practice Location Address
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Address Line | 524 N 19TH ST
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City | ALLENTOWN
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State | PA
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Zip | 18104-5045
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Country | US
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Telephone | 610-351-4848
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Fax | 610-351-4123
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Provider Business Mailing Address
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Address Line | 524 N 19TH ST
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City | ALLENTOWN
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State | PA
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Zip | 18104-5045
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Country | US
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Telephone | 610-351-4848
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Fax | 610-351-4123
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Authorized Official
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Title or Position | OWNER
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Name | DR. SUZANNE MARIE HAUCK
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Credential | O.D.
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Telephone | 610-351-4848
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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 | OE-T008820
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License Number State | PA
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