Provider Demographics
NPI:1407192834
Name:DORSEY C.BLAIR OD PC
Entity Type:Organization
Organization Name:DORSEY C.BLAIR OD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DORSEY
Authorized Official - Middle Name:C
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:281-392-9020
Mailing Address - Street 1:830 S MASON RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-3896
Mailing Address - Country:US
Mailing Address - Phone:281-392-9020
Mailing Address - Fax:281-392-2682
Practice Address - Street 1:830 S MASON RD
Practice Address - Street 2:SUITE A
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-3896
Practice Address - Country:US
Practice Address - Phone:281-392-9020
Practice Address - Fax:281-392-2682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2413TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00E26BMedicare PIN