Jeffrey Scott Blalock, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OPC3085 Issued in FL

Practice address

1524 County Road 220 Ste 5
Fleming Island, FL 32003-4913

Phone

(904) 637-2000

Fax

(904) 637-2001

NPI assigned

Oct 2, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Southern College of Optometry, 1997

Medicare assignment

May accept Medicare assignment

Group practices

Fleming Island Vision Center, Inc.Group PAC ID 9638219793, 2 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Fleming Island Vision Center, Inc.

  • Optometrist
  • Fleming Island, FL
  • NPI 1245482710
  Medicare reassignment Care Compare group NPD Authorized official
• Dr. Ted Brink and Associates PA

  • Optometrist
  • Jacksonville, FL
  • NPI 1427138650
  Medicare reassignment NPD
• Dr.Ted Brink & Associates

  • Optometrist
  • Jacksonville, FL
  • NPI 1730402686
  NPD
• Fleming Island Vision Center

  • Optometrist
  • Orange Park, FL
  • NPI 1861668964
  NPD (past)

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222992000000",
    "number": "1356434237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1524 COUNTY ROAD 220 STE 5",
            "city": "FLEMING ISLAND",
            "state": "FL",
            "postal_code": "320034913",
            "telephone_number": "904-637-2000",
            "fax_number": "904-637-2001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1524 COUNTY ROAD 220 STE 5",
            "city": "FLEMING ISLAND",
            "state": "FL",
            "postal_code": "320034913",
            "telephone_number": "904-637-2000",
            "fax_number": "904-637-2001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLALOCK",
        "first_name": "JEFFREY",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2008-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "FL",
            "license": "OPC3085",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrew Dimitri Bersu
• Beth E. Kailes, DMD, PA
• Constance Louise Biemiller Thomas, LCSW
• Shantavia R Bivens
• Jessika N Blake, APRN
• Morgan M Blom, PHARM.D.
• Kathlene Bobbitt
• Ravi Kiran Bodavula, RPH
• Harley Bogley, A.P.
• Carrie Bohannon, PHARMD

• Optometrist in Fleming Island, FL
• Providers in Fleming Island, FL by specialty
• Optometrist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.