Blake a Housler OD Inc
Organization Active NPI Optometrist · Kane, PA
NPI 1407046451 · NPPES record last updated Feb 18, 2019
Key facts
- NPI
- 1407046451
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Optometrist 152W00000X
- License
- OEG000844 (PA)
- Legal business name
- BLAKE A HOUSLER OD INC
- Practice address
- 175 N Fraley St
Kane, PA 16735-1164 - Phone
- (814) 837-7880
- Fax
- (814) 837-0883
- NPI assigned
- Jul 26, 2007
- Organization subpart
- No
Authorized official
- Name
- Blake A Housler, OD
- Title
- President
- Phone
- (814) 837-7880
Practitioners 21
-
Blake A Housler, OD
-
Christine Dorothy Hajduk, O.D.
-
Tania J Malara, O.D.
-
Faryal Azam, O.D
-
Saadi Marco Darvish, O.D
-
Jennifer E Gipp, O.D.
-
Leann Goslak, OD
-
Kyle Langr, OD
-
Joseph Allan Pruitt, O.D.
-
Tesia Reed, OD
-
Theresa Phuong Anh Vo, O.D.
-
April Wellons, OD
-
Michele M Kane, OD
-
Mary Terese Dacanal, O.D.
-
Andrew C Kartesz, OD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20120306000486 | PA | Part B Supplier - Clinic/Group Practice | 5698893709 |
Receives reassigned benefits from 18 practitioners Practice locations: Smethport, PA |
National Provider Directory
Locations
175 N Fraley St
Kane, PA 16735
Phone (814) 837-7880
422 W Main St
Smethport, PA 16749
Phone (814) 837-7880
215 W Main St
Smethport, PA 16749
Phone (814) 837-7880
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist |
152W00000X | OEG000844 | PA | Yes |
Addresses
Primary practice location
175 N Fraley St
Kane, PA 16735-1164
Mailing address
175 N Fraley St
Kane, PA 16735-1164
Phone (814) 837-7880
Other names
- Allegheny Eye Care
Other providers in Kane, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 18, 2019. 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.