Provider Demographics
NPI:1407379886
Name:BLASCHKE, KYMBER MICHELLE (OD)
Entity Type:Individual
Prefix:DR
First Name:KYMBER
Middle Name:MICHELLE
Last Name:BLASCHKE
Suffix:
Gender:F
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:PO BOX 1054
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78164-1054
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4800 S HULEN ST STE 2720
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76132-1465
Practice Address - Country:US
Practice Address - Phone:817-346-2186
Practice Address - Fax:817-370-7902
Is Sole Proprietor?:No
Enumeration Date:2017-07-18
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9270T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist