Provider Demographics
NPI:1043280977
Name:FRANZEEN, BLAKE BRANDON (OD)
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:BRANDON
Last Name:FRANZEEN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2150 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:GRIMES
Mailing Address - State:IA
Mailing Address - Zip Code:50111-7606
Mailing Address - Country:US
Mailing Address - Phone:515-986-9351
Mailing Address - Fax:515-986-9476
Practice Address - Street 1:2150 E 1ST ST
Practice Address - Street 2:
Practice Address - City:GRIMES
Practice Address - State:IA
Practice Address - Zip Code:50111-7606
Practice Address - Country:US
Practice Address - Phone:515-986-9351
Practice Address - Fax:515-986-9476
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-24
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAIA02224152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIA19362Medicaid
IAIA19362Medicaid