Provider Demographics
NPI:1184009847
Name:BLAND, PAULINE (OD)
Entity Type:Individual
Prefix:
First Name:PAULINE
Middle Name:
Last Name:BLAND
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 30TH ST
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61201-7038
Mailing Address - Country:US
Mailing Address - Phone:309-751-4011
Mailing Address - Fax:309-788-9550
Practice Address - Street 1:1015 13TH AVE N
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:IA
Practice Address - Zip Code:52732-3479
Practice Address - Country:US
Practice Address - Phone:309-751-4011
Practice Address - Fax:309-788-9550
Is Sole Proprietor?:No
Enumeration Date:2015-07-23
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA078286152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist