MEDICARE: DR. TERRY BRUCE BLAIR OD

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	2777T6	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	908516	OTHER		BLOCK VISION
2	117935	OTHER		EYEMED VISION
3	80783Q	OTHER	TX	BLUE CROSS BLUE SHIELD
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	143566	OTHER		COLE VISION

General Provider Information

NPI Number	:	1063402063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERRY BRUCE BLAIR OD

Provider Business Mailing Address
First Line	:	3800 N MESA ST
Second Line	:	STE B1
City	:	EL PASO
State	:	TX
Zip	:	79902-1535
Country	:	US
Telephone Number	:	915-533-1811
Fax Number	:	915-533-3641

Provider Business Practice Location Address
First Line	:	3800 N MESA
Second Line	:	STE C8
City	:	EL PASO
State	:	TX
Zip	:	79902
Country	:	US
Telephone Number	:	915-533-1811
Fax Number	:	915-533-3641

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

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	10/20/2016

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