MEDICARE: DR. JULIE M BLENKER O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2652-035	WI
2	152W00000X	Optometrist	2573	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043265267
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIE M BLENKER O.D.

Provider Business Mailing Address
First Line	:	7244 CRANE DR
Second Line	:
City	:	LINO LAKES
State	:	MN
Zip	:	55038-4701
Country	:	US
Telephone Number	:	763-292-0101
Fax Number	:	651-788-9695

Provider Business Practice Location Address
First Line	:	261 RUTH ST N STE E
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55119-4337
Country	:	US
Telephone Number	:	651-739-5173
Fax Number	:	651-739-8907

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	03/25/2023

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