Provider Demographics
NPI:1639271216
Name:BLACKBURN, DON D (OD)
Entity Type:Individual
Prefix:DR
First Name:DON
Middle Name:D
Last Name:BLACKBURN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3105 LIMESTONE RD
Mailing Address - Street 2:STE 102
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-2147
Mailing Address - Country:US
Mailing Address - Phone:302-998-1395
Mailing Address - Fax:302-998-6784
Practice Address - Street 1:3105 LIMESTONE RD
Practice Address - Street 2:STE 102
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-2147
Practice Address - Country:US
Practice Address - Phone:302-998-1395
Practice Address - Fax:302-998-6784
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000275152W00000X, 152WV0400X, 156FX1800X
DEI3-0001218152WV0400X, 152W00000X, 152WS0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152W00000XEye and Vision Services ProvidersOptometrist
No156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
341988702OtherDEVON
3684782OtherAETNA
221393OtherEYEMED
5178130OtherAETNA
DE03105OtherVBA
DE341988702OtherBCBS
13029981395OtherVSP
DE258125OtherCOVENTRY
DE341988702OtherBCBS
5178130OtherAETNA