Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 24730 | NC |
Y | 207W00000X | Ophthalmologist | 24730 | NC |
NPI | 1235195827 |
---|---|
Provider Name | Mr. William S Blakemore |
First Address | Edenton, NC 27932-1077 |
Second Address | Edenton, NC 27932-1704 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2006 |
Last Update Date | 25/05/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
16180 | BC (01) | |
180002116 | RAILROAD MEDICARE (01) | NC |
8916180 | (05) | NC |
D62770 | (02) |