Blahnik Eye Care Inc
Organization Active NPI Optometrist · Port Orange, FL
NPI 1043462914 · NPPES record last updated Mar 5, 2010
Key facts
- NPI
- 1043462914
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- OPC2215 (FL)
- Legal business name
- BLAHNIK EYE CARE INC
- Practice address
- 3740 S Ridgewood Ave
Unit 103
Port Orange, FL 32129-3510 - Phone
- (386) 492-6999
- Fax
- (386) 492-6900
- NPI assigned
- Oct 22, 2008
- Organization subpart
- No
Authorized official
- Name
- Dr. Suzette A Blahnik, O.D.
- Title
- President
- Phone
- (386) 492-6999
Practitioners 4
-
Kathryn Blahnik, O.D.
-
Suzette Ann Blahnik, O.D.
-
Gregory Francis Blahnik, O.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20090326000447 | FL | Part B Supplier - Clinic/Group Practice | 4385701903 |
Receives reassigned benefits from 4 practitioners Practice locations: Port Orange, FL |
National Provider Directory
Locations
3740 S Ridgewood Ave
Port Orange, FL 32129
3740 S Ridgewood Ave
Unit 103
Port Orange, FL 32129
Phone (386) 492-6999
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | OPC2215 | FL | Yes |
Addresses
Primary practice location
3740 S Ridgewood Ave
Unit 103
Port Orange, FL 32129-3510
Mailing address
3740 S Ridgewood Ave
Unit 103
Port Orange, FL 32129-3510
Phone (386) 492-6999
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00781100 | Medicaid | FL |
Other providers in Port Orange, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 5, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.