Provider Demographics
NPI:1396386843
Name:BLAIR VISION CARE, LLC
Entity Type:Organization
Organization Name:BLAIR VISION CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:719-431-6434
Mailing Address - Street 1:3958 N ACADEMY BLVD STE 108
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-5911
Mailing Address - Country:US
Mailing Address - Phone:719-999-8404
Mailing Address - Fax:719-999-8402
Practice Address - Street 1:3958 N ACADEMY BLVD STE 108
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-5911
Practice Address - Country:US
Practice Address - Phone:719-999-8404
Practice Address - Fax:719-999-8402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-07
Last Update Date:2019-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty