Provider Demographics
NPI:1952474611
Name:BLANKMAN, STUART H (OD)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:H
Last Name:BLANKMAN
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 1:2472 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-7449
Mailing Address - Country:US
Mailing Address - Phone:212-362-8090
Mailing Address - Fax:212-875-1488
Practice Address - Street 1:2472 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-7449
Practice Address - Country:US
Practice Address - Phone:212-362-8090
Practice Address - Fax:212-875-1488
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV002630152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00330896Medicaid
NYT81407Medicare UPIN
NY00330896Medicaid
NY0622330001Medicare NSC