Provider Demographics
NPI:1235324500
Name:BUCKER, BLYTHE (OD)
Entity Type:Individual
Prefix:DR
First Name:BLYTHE
Middle Name:
Last Name:BUCKER
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 1:10000 EMMETT F LOWRY EXPY
Mailing Address - Street 2:SEARS BLDG.
Mailing Address - City:TEXAS CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77591-2127
Mailing Address - Country:US
Mailing Address - Phone:409-986-4088
Mailing Address - Fax:409-986-5692
Practice Address - Street 1:10000 EMMETT F LOWRY EXPY
Practice Address - Street 2:SEARS BLDG.
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591-2127
Practice Address - Country:US
Practice Address - Phone:409-986-4088
Practice Address - Fax:409-986-5692
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4010152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist