Provider Demographics
NPI:1376011494
Name:BLEVINS, BRIAN D (ABOC)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:D
Last Name:BLEVINS
Suffix:
Gender:M
Credentials:ABOC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HIGHLAND MEADOWS CIR STE 11
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND HEIGHTS
Mailing Address - State:KY
Mailing Address - Zip Code:41076-1788
Mailing Address - Country:US
Mailing Address - Phone:317-690-2259
Mailing Address - Fax:
Practice Address - Street 1:30 HIGHLAND MEADOWS CIR STE 11
Practice Address - Street 2:
Practice Address - City:HIGHLAND HEIGHTS
Practice Address - State:KY
Practice Address - Zip Code:41076-1788
Practice Address - Country:US
Practice Address - Phone:317-690-2259
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-06
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician