Provider Demographics
NPI:1629187208
Name:BLINK LLC
Entity Type:Organization
Organization Name:BLINK LLC
Other - Org Name:LAKEPOINTE VISION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:EGHIGIAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:618-624-3937
Mailing Address - Street 1:1003 E WESLEY DR
Mailing Address - Street 2:STE A
Mailing Address - City:O FALLON
Mailing Address - State:IL
Mailing Address - Zip Code:62269-6137
Mailing Address - Country:US
Mailing Address - Phone:618-624-3937
Mailing Address - Fax:618-624-3940
Practice Address - Street 1:1003 E WESLEY DR
Practice Address - Street 2:STE A
Practice Address - City:O FALLON
Practice Address - State:IL
Practice Address - Zip Code:62269-6137
Practice Address - Country:US
Practice Address - Phone:618-624-3937
Practice Address - Fax:618-624-3940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2015-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008912152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDP2153Medicare PIN
ILL70902Medicare PIN
ILU69475Medicare UPIN