Provider Demographics
NPI:1558429084
Name:BLANCHARD, ANGELA SALAS (OD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:SALAS
Last Name:BLANCHARD
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 1:15202 KEVIN LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78734-2342
Mailing Address - Country:US
Mailing Address - Phone:512-394-6263
Mailing Address - Fax:
Practice Address - Street 1:5601 BRODIE LN
Practice Address - Street 2:SUITE 530
Practice Address - City:SUNSET VALLEY
Practice Address - State:TX
Practice Address - Zip Code:78745-2538
Practice Address - Country:US
Practice Address - Phone:512-358-8200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6857T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81692QOtherBCBS