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General NPI Number Information
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NPI Number | 1912147869
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Entity Type | Organization
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Legal Business Name | BURTON C BLAUROCK OD
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Dates
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Enumeration Date | 03/04/2009
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Last Update Date | 04/15/2009
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Provider Practice Location Address
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Address Line | 42390 BOB HOPE DR
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-4469
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Country | US
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Telephone | 760-340-4524
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Fax | 760-340-4796
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Provider Business Mailing Address
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Address Line | 42390 BOB HOPE DR
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City | RANCHO MIRAGE
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State | CA
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Zip | 92270-4469
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Country | US
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Telephone | 760-340-4524
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Fax | 760-340-4796
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Authorized Official
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Title or Position | OWNER
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Name | DR. BURTON CHARLES BLAUROCK
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Credential | OPTOMETRIST
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Telephone | 760-340-4524
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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 | 5996T
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License Number State | CA
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