Provider Demographics
NPI:1376908095
Name:BLACKMER FAMILY EYEWEAR
Entity Type:Organization
Organization Name:BLACKMER FAMILY EYEWEAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED OPTICIAN/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:HAN
Authorized Official - Middle Name:SONG
Authorized Official - Last Name:BLACKMER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-857-5402
Mailing Address - Street 1:9519 BREWERTON RD STE 119
Mailing Address - Street 2:
Mailing Address - City:BREWERTON
Mailing Address - State:NY
Mailing Address - Zip Code:13029-9715
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9519 BREWERTON RD STE 119
Practice Address - Street 2:
Practice Address - City:BREWERTON
Practice Address - State:NY
Practice Address - Zip Code:13029-9715
Practice Address - Country:US
Practice Address - Phone:315-857-5402
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-22
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY55 006556332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier