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General NPI Number Information
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NPI Number | 1700951217
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Entity Type | Organization
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Legal Business Name | DR. TAYLOR BLADH, O.D., INC
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Dates
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Enumeration Date | 11/21/2006
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Last Update Date | 07/03/2012
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Provider Practice Location Address
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Address Line | 718 N. DIAMOND BAR BLVD
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City | DIAMOND BAR
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State | CA
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Zip | 91765-4122
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Country | US
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Telephone | 909-861-3737
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Fax | 909-396-7517
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Provider Business Mailing Address
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Address Line | 718 N. DIAMOND BAR BLVD.
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City | DIAMOND BAR
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State | CA
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Zip | 91765-4122
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Country | US
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Telephone | 909-861-3737
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Fax | 909-396-7517
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Authorized Official
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Title or Position | PRESIDENT/ OPTOMETRIST
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Name | DR. TAYLOR WOODBURY BLADH
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Credential | O.D.
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Telephone | 909-861-3737
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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 |
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License Number State | CA
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