MEDICARE: DR. KELSEY BLALOCK 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	TN3977	TN

General Provider Information

NPI Number	:	1972346500
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KELSEY BLALOCK OD

Provider Business Mailing Address
First Line	:	5415 WASHINGTON PIKE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37918-7004
Country	:	US
Telephone Number	:	865-217-1010
Fax Number	:

Provider Business Practice Location Address
First Line	:	5415 WASHINGTON PIKE
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37918-7004
Country	:	US
Telephone Number	:	865-217-1010
Fax Number	:

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

Provider Enumeration Date	:	06/12/2024
Last Update Date	:	01/27/2026

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