Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 931158T | LA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 931-158T | LA |
NPI | 1235212085 |
---|---|
Provider Name | Scott M Blahnik |
First Address | Terrytown, LA 70056 |
Second Address | Terrytown, LA 70056-5502 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 19/07/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1370851 | (05) | LA |