Frederick Donald Blank
Individual provider Active NPI Optometrist · Cleveland, OH
NPI 1508905241 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1508905241
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Optometrist 152W00000X
- License
- #2856 (OH)
- Practice address
- 2512 Clark Ave
Cleveland, OH 44109-1111 - Phone
- (216) 241-2040
- NPI assigned
- Feb 6, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| #2856 | OH | MD | Optometrist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | #2856 | OH | Yes |
Addresses
Primary practice location
2512 Clark Ave
Cleveland, OH 44109-1111
Mailing address
2512 Clark Ave
Cleveland, OH 44109-1111
Phone (216) 241-2040
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0248084 | Medicaid | OH |
Other names
- Dr. Frederick Donald Blank
Other providers in Cleveland, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.