Provider Demographics
NPI:1952497778
Name:BLUMKIN, AGNESS (DOCTOR OF OPTOMETRY)
Entity Type:Individual
Prefix:DR
First Name:AGNESS
Middle Name:
Last Name:BLUMKIN
Suffix:
Gender:F
Credentials:DOCTOR OF OPTOMETRY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1723 AVENUE U
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-3811
Mailing Address - Country:US
Mailing Address - Phone:718-998-8400
Mailing Address - Fax:718-998-2500
Practice Address - Street 1:1723 AVENUE U
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-3811
Practice Address - Country:US
Practice Address - Phone:718-998-8400
Practice Address - Fax:718-998-2500
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT006198152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02263683Medicaid
NYP3332179OtherOXFORD
NY0101473-05OtherAMERICHOICE
NY0101473-05OtherAMERICHOICE
NYP3332179OtherOXFORD