Provider Demographics
NPI:1891889267
Name:SILVERBLATT, SAM RAY (OD)
Entity Type:Individual
Prefix:DR
First Name:SAM
Middle Name:RAY
Last Name:SILVERBLATT
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 1:1803 E 70TH ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5301
Mailing Address - Country:US
Mailing Address - Phone:318-798-4000
Mailing Address - Fax:318-798-4001
Practice Address - Street 1:1803 E 70TH ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5301
Practice Address - Country:US
Practice Address - Phone:318-798-4000
Practice Address - Fax:318-798-4001
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA900-86T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAT19631Medicare UPIN
LA49244Medicare PIN