MEDICARE: MARY LYNNE BLEVINS 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	3739	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	410046640	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

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

General Provider Information

NPI Number	:	1275612525
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY LYNNE BLEVINS O.D.

Provider Business Mailing Address
First Line	:	503 E MAIN ST
Second Line	:
City	:	LOUISVILLE
State	:	OH
Zip	:	44641-1421
Country	:	US
Telephone Number	:	330-875-2300
Fax Number	:	330-875-4110

Provider Business Practice Location Address
First Line	:	503 E MAIN ST
Second Line	:
City	:	LOUISVILLE
State	:	OH
Zip	:	44641-1421
Country	:	US
Telephone Number	:	330-875-2300
Fax Number	:	330-875-4110

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

Provider Enumeration Date	:	11/06/2006
Last Update Date	:	10/27/2008

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