Mark Allan Blackledge, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

2015007758 Issued in MO

Practice address

5107 N Belt Hwy Ste Y107
Saint Joseph, MO 64506-1280

Phone

(308) 530-6666

NPI assigned

May 5, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

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.

• North Platte Vision Center, LLC

  • Eyewear Supplier
  • North Platte, NE
  • NPI 1992986467

  Optometrist

  NPD (past) Authorized official
• Lake Avenue Eyecare LLC

  • Eyewear Supplier
  • Gothenburg, NE
  • NPI 1396932430

  Optometrist

  NPD (past)
• Lake Avenue Eyecare, LLC

  • Optometrist
  • Gothenburg, NE
  • NPI 1811183783
  NPD (past)

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

{
    "created_epoch": "1146787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1520812800000",
    "number": "1679521397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5107 N BELT HWY STE Y107",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645061280",
            "telephone_number": "308-530-6666"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5107 N BELT HWY STE Y107",
            "city": "SAINT JOSEPH",
            "state": "MO",
            "postal_code": "645061280",
            "telephone_number": "308-530-6666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKLEDGE",
        "first_name": "MARK",
        "middle_name": "ALLAN",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-05",
        "last_updated": "2018-03-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NE",
            "license": "953",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MO",
            "license": "2015007758",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bioderm Laboratories LLC
• Bonnie Lee Birchansky, MD
• Alejandro Blachar, M.D
• Deborah Blachar, MD
• Michelle A Black
• Ethan Blair, MA, PLPC
• David A Blaker, CRNA
• Terra Brean Blanchard, CPM
• Kevin Bland
• Amber Evelyn Blattner, M.A., CCC-SLP

• Optometrist in Saint Joseph, MO
• Providers in Saint Joseph, MO by specialty
• Optometrist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 12, 2018; 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.