Provider Demographics
NPI:1326267352
Name:BLACKIE, CAROLINE ADRIENNE (OD, PHD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:ADRIENNE
Last Name:BLACKIE
Suffix:
Gender:F
Credentials:OD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 BOSTON ST
Mailing Address - Street 2:
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-6203
Mailing Address - Country:US
Mailing Address - Phone:978-208-8561
Mailing Address - Fax:
Practice Address - Street 1:50 MALL RD
Practice Address - Street 2:SUITE 114
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-4537
Practice Address - Country:US
Practice Address - Phone:781-229-2020
Practice Address - Fax:781-229-2025
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4349152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MABLW51332Medicare ID - Type Unspecified