Provider Demographics
NPI:1720018872
Name:BLOWERS, MISSY A (OD)
Entity Type:Individual
Prefix:DR
First Name:MISSY
Middle Name:A
Last Name:BLOWERS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:MISSY
Other - Middle Name:A
Other - Last Name:BLOWERS SUMMERFIELD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:122 TRINITY PL
Mailing Address - Street 2:
Mailing Address - City:SELKIRK
Mailing Address - State:NY
Mailing Address - Zip Code:12158-8706
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:122 TRINITY PL
Practice Address - Street 2:
Practice Address - City:SELKIRK
Practice Address - State:NY
Practice Address - Zip Code:12158-8706
Practice Address - Country:US
Practice Address - Phone:518-459-5397
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV005693-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP00419426OtherRAILROAD MEDICARE
NYRB8217Medicare PIN
NYP00419426OtherRAILROAD MEDICARE
J400000905Medicare PIN
NYIA1016Medicare PIN