Carl Joseph Blackburn, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

1771TG Issued in TX

Practice address

5655 E Sam Houston Pkwy N
A
Houston, TX 77015-3250

Phone

(713) 450-4484

Fax

(713) 450-4424

NPI assigned

Jun 28, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1083641476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7619 DOLPHIN ARC DR",
            "city": "HUMBLE",
            "state": "TX",
            "postal_code": "773468199",
            "telephone_number": "713-450-4484",
            "fax_number": "713-450-4424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5655 E SAM HOUSTON PKWY N",
            "address_2": "A",
            "city": "HOUSTON",
            "state": "TX",
            "postal_code": "770153250",
            "telephone_number": "713-450-4484",
            "fax_number": "713-450-4424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKBURN",
        "first_name": "CARL",
        "middle_name": "JOSEPH",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "TX",
            "license": "1771TG",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "158706501",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robin R Black
• Samuel Cluett Black
• Sarah Black
• Tonee Black
• Troy Austin Black, MD
• Jamie Blackburn, MA, LPC
• Kyle Warren Blackburn, MD
• Laura Blackburn, PHARMD
• Nicke Theresa Blackburn, M.D.
• Payton Blackburn, MD

• Optometrist in Houston, TX
• Providers in Houston, TX by specialty
• Optometrist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.