Provider Demographics
NPI:1689237018
Name:BLANKENSHIP, BROOKE NAOMI
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:NAOMI
Last Name:BLANKENSHIP
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5488 S PADRE ISLAND DR STE 2042
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78411-4122
Mailing Address - Country:US
Mailing Address - Phone:361-994-0310
Mailing Address - Fax:361-994-0452
Practice Address - Street 1:5488 S PADRE ISLAND DR STE 2042
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78411-4122
Practice Address - Country:US
Practice Address - Phone:361-994-0310
Practice Address - Fax:361-994-0452
Is Sole Proprietor?:No
Enumeration Date:2019-04-22
Last Update Date:2019-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPENDING152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist