Michael G Blake and Associates Inc.

Primary specialty

OptometristTaxonomy code 152W00000X

Legal business name

MICHAEL G BLAKE AND ASSOCIATES INC.

Practice address

124 W Coal Ave
Gallup, NM 87301-6206

Phone

(505) 722-2020

Fax

(505) 863-2204

NPI assigned

Dec 16, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Michael G Blake, O.D.

Title

Optometrist

Phone

(505) 722-2020

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Gallup Vision Source Other name

Locations

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

{
    "created_epoch": "1229385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1229385600000",
    "number": "1912142241",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "124 WEST COAL AVE",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "87301",
            "telephone_number": "505-722-2020",
            "fax_number": "505-863-2204"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "124 W COAL AVE",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873016206",
            "telephone_number": "505-722-2020",
            "fax_number": "505-863-2204"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL G BLAKE AND ASSOCIATES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-12-16",
        "last_updated": "2008-12-16",
        "status": "A",
        "authorized_official_last_name": "BLAKE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OPTOMETRIST",
        "authorized_official_telephone_number": "505-722-2020",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD NM",
            "identifier": "NM00O520",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Gallup Vision Source",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Beatrice Mescal, RN
• Laureen Metcalf, RN
• Leander Meyers
• John M. Mezoff, M.D.
• Kathleen Mezoff, MD
• Taylor Scott Middleton, PHARMD
• Deborah Lamora Mierva, RN
• Richard Mierva, REGISTERED RN
• Judette Miguel
• Margaret Milam, RN

• Optometrist in Gallup, NM
• Providers in Gallup, NM by specialty
• Optometrist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2008; 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.