Provider Demographics
NPI:1255324158
Name:BLANKENSHIP, SHERYL L (OD)
Entity Type:Individual
Prefix:DR
First Name:SHERYL
Middle Name:L
Last Name:BLANKENSHIP
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 1:18481 W CAMPBELL LOOP
Mailing Address - Street 2:
Mailing Address - City:BAKER CITY
Mailing Address - State:OR
Mailing Address - Zip Code:97814-8412
Mailing Address - Country:US
Mailing Address - Phone:541-523-9358
Mailing Address - Fax:
Practice Address - Street 1:2150 3RD ST
Practice Address - Street 2:
Practice Address - City:BAKER CITY
Practice Address - State:OR
Practice Address - Zip Code:97814-2609
Practice Address - Country:US
Practice Address - Phone:541-523-5858
Practice Address - Fax:541-523-7652
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-25
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1773AT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR144436Medicaid
ORMB0963620OtherDEA
OR00WCKCFBMedicare ID - Type Unspecified
T67434Medicare UPIN