Provider Demographics
NPI:1508217332
Name:BLENKER EYE CARE PLLC
Entity Type:Organization
Organization Name:BLENKER EYE CARE PLLC
Other - Org Name:SCENIC EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLENKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-292-0101
Mailing Address - Street 1:7244 CRANE DR
Mailing Address - Street 2:
Mailing Address - City:LINO LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:55038-4701
Mailing Address - Country:US
Mailing Address - Phone:763-292-0101
Mailing Address - Fax:
Practice Address - Street 1:261 RUTH ST N STE E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55119-4337
Practice Address - Country:US
Practice Address - Phone:651-739-5173
Practice Address - Fax:651-739-8907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-22
Last Update Date:2023-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2573152W00000X
332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNU63110Medicare UPIN