Provider Demographics
NPI:1427356252
Name:BLADE VISION SERVICES LLC
Entity Type:Organization
Organization Name:BLADE VISION SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:JISELLE
Authorized Official - Last Name:BLADE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:513-219-6054
Mailing Address - Street 1:PO BOX 111
Mailing Address - Street 2:
Mailing Address - City:SOUTH LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45065-0111
Mailing Address - Country:US
Mailing Address - Phone:513-319-6054
Mailing Address - Fax:
Practice Address - Street 1:11564 SPRINGFIELD PIKE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-3527
Practice Address - Country:US
Practice Address - Phone:513-671-3443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-02
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5931152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty