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General NPI Number Information
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NPI Number | 1700034931
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Entity Type | Individual
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Provider Name | ROBERT M BLANKENBEHLER O.D
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Gender | Male
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Dates
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Enumeration Date | 08/29/2008
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 12000 W CARMEN AVE
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City | MILWAUKEE
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State | WI
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Zip | 53225-2196
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Country | US
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Telephone | 414-462-1300
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Fax |
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Provider Business Mailing Address
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Address Line | 12140 W LIBERTY CT
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City | HALES CORNERS
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State | WI
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Zip | 53130-1772
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Country | US
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Telephone | 414-389-7275
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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 | 4901004494
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License Number State | MI
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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 | 3176
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License Number State | WI
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