Provider Demographics
NPI:1386654275
Name:BLAIR, ROBERT EUGENE JR (OD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:EUGENE
Last Name:BLAIR
Suffix:JR
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 1:287 SE SUMPTER CT
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64063-3669
Mailing Address - Country:US
Mailing Address - Phone:816-213-9948
Mailing Address - Fax:
Practice Address - Street 1:1700 N STATE ROUTE 291
Practice Address - Street 2:
Practice Address - City:HARRISONVILLE
Practice Address - State:MO
Practice Address - Zip Code:64701-1218
Practice Address - Country:US
Practice Address - Phone:816-884-5845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005019123152W00000X
KS1711152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSR07E47AMedicaid
R07E427AMedicare ID - Type Unspecified
KSR07E47AMedicaid