Samantha Ann Blanke, OD
Individual provider Active NPI Optometrist · Ft Mitchell, KY
NPI 1245929140 · NPPES record last updated Jul 18, 2024
Key facts
- NPI
- 1245929140
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- ATI4665 (OR)
- Practice address
- 2174 Dixie Hwy
Ft Mitchell, KY 41017-2972 - Phone
- (859) 341-2566
- NPI assigned
- May 5, 2023
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare Care Compare profile
- Specialty
- Optometry
- Education
- Southern College of Optometry, 2023
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Dr Shewmaker and Associates Optometrists Inc
Practice addresses (Care Compare)
2174 Dixie Hwy
Suite a
Fort Mitchell, KY 41017-2972
Phone (859) 341-2566
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240903001463 | KY | Practitioner - Optometry | 4082153192 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| ATI4665 | OR | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dr Shewmaker & Associates Optometrists Inc | Optometrist | Current |
Accepting new patients |
| Dr Shewmaker & Associates Optometrists Inc | Optometrist | Current |
Accepting new patients |
Locations
1114 Fashion Ridge Rd
#1
Dry Ridge, KY 41035
Phone (859) 824-4415
1114 Fashion Ridge Rd
Dry Ridge, KY 41035
Phone (859) 824-4415
2174 Dixie Hwy
Ft Mitchell, KY 41017
Phone (606) 341-2566
2174 Dixie Hwy
Ste A
Ft Mitchell, KY 41017
Phone (859) 341-2566
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Optometrist | 152W00000X | ATI4665 | OR | Yes |
Addresses
Primary practice location
2174 Dixie Hwy
Ft Mitchell, KY 41017-2972
Mailing address
3405 Woodland Dr
Manitowoc, WI 54220-9664
Phone (920) 905-2836
Other practice location 1
1114 Fashion Ridge Rd # Vision1
Dry Ridge, KY 41035-9609
Phone (859) 824-4415
Other practice location 2
15259 SE 82nd Dr Ste 101
Clackamas, OR 97015-6609
Phone (920) 905-2836
Other providers in Ft Mitchell, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 18, 2024. 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.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.