Provider Demographics
NPI:1225192917
Name:BLANKENSHIP, THOMAS ANDREW (OD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ANDREW
Last Name:BLANKENSHIP
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3524 KNICKERBOCKER RD
Mailing Address - Street 2:STE C PMB 337
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904
Mailing Address - Country:US
Mailing Address - Phone:325-947-2020
Mailing Address - Fax:325-947-2021
Practice Address - Street 1:5501 SHERWOOD WAY
Practice Address - Street 2:STE A
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-9738
Practice Address - Country:US
Practice Address - Phone:325-947-2020
Practice Address - Fax:325-947-2021
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2020-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6497TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
8B6692Medicare ID - Type Unspecified
TXU99294Medicare UPIN
TXTXB103639Medicare PIN