Provider Demographics
NPI:1689351082
Name:BLINK BOUTIQUE EYECARE & EYEWEAR PLLC
Entity Type:Organization
Organization Name:BLINK BOUTIQUE EYECARE & EYEWEAR PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:Q
Authorized Official - Last Name:PHAM
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:737-225-8644
Mailing Address - Street 1:501 S AUSTIN AVE UNIT 1145
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78626-5640
Mailing Address - Country:US
Mailing Address - Phone:737-225-8644
Mailing Address - Fax:
Practice Address - Street 1:501 S AUSTIN AVE UNIT 1145
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-5640
Practice Address - Country:US
Practice Address - Phone:737-225-8644
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-28
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty