Provider Demographics
NPI:1235212085
Name:BLAHNIK, SCOTT M (OD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:M
Last Name:BLAHNIK
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 1:93 TERRY PARKWAY
Mailing Address - Street 2:SUITE 9
Mailing Address - City:TERRYTOWN
Mailing Address - State:LA
Mailing Address - Zip Code:70056
Mailing Address - Country:US
Mailing Address - Phone:504-361-4446
Mailing Address - Fax:504-361-4695
Practice Address - Street 1:93 TERRY PKWY
Practice Address - Street 2:SUITE 9
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056-5502
Practice Address - Country:US
Practice Address - Phone:504-361-4446
Practice Address - Fax:504-361-4695
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA931-158T152WC0802X
LA931158T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1370851Medicaid
LA1370851Medicaid