Connor Blake, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OEG003850 Issued in PA

Practice address

494 Gateway Ave
Chambersburg, PA 17201-7351

Phone

(717) 263-6186

Fax

(717) 263-6888

NPI assigned

Dec 31, 2019

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

Enrolled in MD

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

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cblake017609@myeyedr.emadirect.md

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.

• Myeyedr Optometry of Maryland, LLC

  • Optometrist
  • Waldorf, MD
  • NPI 1609204437
  Medicare reassignment NPD
• Myeyedr Optometry of Pennsylvania, LLC

  • Optometrist
  • Carlisle, PA
  • NPI 1003264607
  NPD
• Myeyedr Optometry of Pennsylvania, LLC

  • Optometrist
  • Cranberry Township, PA
  • NPI 1093688491
  NPD
• Myeyedr Optometry of Pennsylvania, LLC

  • Optometrist
  • Latrobe, PA
  • NPI 1457991846
  NPD
• Myeyedr Optometry of Maryland, LLC

  • Optometrist
  • Waldorf, MD
  • NPI 1689042400
  NPD
• Myeyedr Optometry of Maryland, LLC

  • Optometrist
  • Laurel, MD
  • NPI 1972900058
  NPD

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

{
    "created_epoch": "1577750400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633910400000",
    "number": "1972142545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1950 OLD GALLOWS RD STE 520",
            "city": "VIENNA",
            "state": "VA",
            "postal_code": "221823970",
            "telephone_number": "703-847-8899",
            "fax_number": "571-233-6780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "494 GATEWAY AVE",
            "city": "CHAMBERSBURG",
            "state": "PA",
            "postal_code": "172017351",
            "telephone_number": "717-263-6186",
            "fax_number": "717-263-6888"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "17301 Valley Mall Rd",
            "address_purpose": "LOCATION",
            "city": "Hagerstown",
            "state": "MD",
            "postal_code": "217406966",
            "country_code": "US",
            "telephone_number": "301-582-1771",
            "fax_number": "301-582-4681",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "CONNOR",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-12-31",
        "last_updated": "2021-10-11",
        "certification_date": "2021-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "MD",
            "license": "TA2748",
            "primary": false
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "PA",
            "license": "OEG003850",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Optometrist in Chambersburg, PA
• Providers in Chambersburg, PA by specialty
• Optometrist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.