Provider Demographics
NPI:1851492201
Name:CHRISTINE Y BLICK OD PA
Entity Type:Organization
Organization Name:CHRISTINE Y BLICK OD PA
Other - Org Name:ENVISION EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:BLICK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-566-8505
Mailing Address - Street 1:502 CELEBRATION AVE
Mailing Address - Street 2:
Mailing Address - City:CELEBRATION
Mailing Address - State:FL
Mailing Address - Zip Code:34747-4687
Mailing Address - Country:US
Mailing Address - Phone:407-588-8505
Mailing Address - Fax:407-566-8253
Practice Address - Street 1:502 CELEBRATION AVE
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-4687
Practice Address - Country:US
Practice Address - Phone:407-566-8585
Practice Address - Fax:407-566-8253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL6468970001Medicare NSC
FLCH187AMedicare PIN