Doctor Name: | MR. HAN BLACKMER |
NPI Number: | 1376916205 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | 55-006556 |
Business Practice Address: | 9519 Brewerton Rd Ste 119 Brewerton, NY - 130299715 |
Business Phone Number: | 3158575800 |
Business Fax Number: | |
Mailing Address: | 9519 Brewerton Rd Ste 119, BREWERTON |
State: | NY |
Postal Code: | 130299715 |
Phone Number: | 3158575800 |
Fax Number: | |
NPI Enumeration Date: | 10/30/2015 |
NPI Last Update Date: | 12/22/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 156FX1800X |
License Number: | 55-006556 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NY |
Taxonomy Type: | Eye and Vision Services Providers |
Taxonomy Classification: | Technician/Technologist |
Taxonomy Specialization: | Optician |
Taxonomy Definition: |