Provider Demographics
NPI:1376916205
Name:BLACKMER, HAN
Entity Type:Individual
Prefix:MR
First Name:HAN
Middle Name:
Last Name:BLACKMER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:315-857-5800
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:315-857-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-30
Last Update Date:2015-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY55-006556156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician