Provider Demographics
NPI:1043462914
Name:BLAHNIK EYE CARE INC
Entity Type:Organization
Organization Name:BLAHNIK EYE CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZETTE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLAHNIK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:386-492-6999
Mailing Address - Street 1:3740 S RIDGEWOOD AVE
Mailing Address - Street 2:UNIT 103
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32129-3510
Mailing Address - Country:US
Mailing Address - Phone:386-492-6999
Mailing Address - Fax:386-492-6900
Practice Address - Street 1:3740 S RIDGEWOOD AVE
Practice Address - Street 2:UNIT 103
Practice Address - City:PORT ORANGE
Practice Address - State:FL
Practice Address - Zip Code:32129-3510
Practice Address - Country:US
Practice Address - Phone:386-492-6999
Practice Address - Fax:386-492-6900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2215152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00781100Medicaid
FL00781100Medicaid
6281360001Medicare NSC