Provider Demographics
NPI:1689642290
Name:BLODI, CHRISTOPHER FREDERICK (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:FREDERICK
Last Name:BLODI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:988102 NEBRASKA MEDICAL CTR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68198-8102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3902 LEAVENWORTH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-1119
Practice Address - Country:US
Practice Address - Phone:402-559-2020
Practice Address - Fax:402-559-2267
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2019-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA23468207WX0107X
NE31257207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0080010Medicaid
A14470Medicare UPIN
IA0080010Medicaid