Provider Demographics
NPI:1285018952
Name:HOUSLER, BLAKE A (OD)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:A
Last Name:HOUSLER
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 1:175 N FRALEY ST
Mailing Address - Street 2:
Mailing Address - City:KANE
Mailing Address - State:PA
Mailing Address - Zip Code:16735-1164
Mailing Address - Country:US
Mailing Address - Phone:814-837-7880
Mailing Address - Fax:814-837-0883
Practice Address - Street 1:175 N FRALEY ST
Practice Address - Street 2:
Practice Address - City:KANE
Practice Address - State:PA
Practice Address - Zip Code:16735-1164
Practice Address - Country:US
Practice Address - Phone:814-837-7880
Practice Address - Fax:814-837-0883
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG003042152W00000X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation