MEDICARE: DR. ANGELA SALAS BLANCHARD 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	6857T	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	81692Q	OTHER	TX	BCBS

General Provider Information

NPI Number	:	1558429084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANGELA SALAS BLANCHARD O.D.

Provider Business Mailing Address
First Line	:	15202 KEVIN LN
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78734-2342
Country	:	US
Telephone Number	:	512-394-6263
Fax Number	:

Provider Business Practice Location Address
First Line	:	5601 BRODIE LN
Second Line	:	SUITE 530
City	:	SUNSET VALLEY
State	:	TX
Zip	:	78745-2538
Country	:	US
Telephone Number	:	512-358-8200
Fax Number	:

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	12/28/2007

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