Provider Demographics
NPI:1891424230
Name:BLANCHARD, GERARD KEVIN SR (LICENSED OPTICIAN)
Entity Type:Individual
Prefix:MR
First Name:GERARD
Middle Name:KEVIN
Last Name:BLANCHARD
Suffix:SR
Gender:M
Credentials:LICENSED OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2795 NORTH RD
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-2806
Mailing Address - Country:US
Mailing Address - Phone:803-533-1622
Mailing Address - Fax:803-533-4335
Practice Address - Street 1:2795 NORTH RD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-2806
Practice Address - Country:US
Practice Address - Phone:803-533-1622
Practice Address - Fax:803-533-4335
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC796156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician