Provider Demographics
NPI:1477523090
Name:BLACKSTONE, JAMES WAID (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:WAID
Last Name:BLACKSTONE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 W SPRING ST
Mailing Address - Street 2:
Mailing Address - City:SYLACAUGA
Mailing Address - State:AL
Mailing Address - Zip Code:35150-2924
Mailing Address - Country:US
Mailing Address - Phone:256-245-5203
Mailing Address - Fax:
Practice Address - Street 1:210 W SPRING ST
Practice Address - Street 2:
Practice Address - City:SYLACAUGA
Practice Address - State:AL
Practice Address - Zip Code:35150-2924
Practice Address - Country:US
Practice Address - Phone:256-245-5203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL24790207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051001264OtherBLUE CROSS BLUE SHIELD AL
AL009932211Medicaid
AL202682193OtherTRICARE
AL7541689OtherAETNA