Provider Demographics
NPI:1689671992
Name:BLONDER, BARRY DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:DAVID
Last Name:BLONDER
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 1:6159 E BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-4028
Mailing Address - Country:US
Mailing Address - Phone:520-790-2020
Mailing Address - Fax:520-790-8328
Practice Address - Street 1:6159 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-4028
Practice Address - Country:US
Practice Address - Phone:520-790-2020
Practice Address - Fax:520-790-8328
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-01
Last Update Date:2007-07-08
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
AZ19152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist