Provider Demographics
NPI:1972130862
Name:BLACKWELDER OPTOMETRY, PLLC
Entity Type:Organization
Organization Name:BLACKWELDER OPTOMETRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKWELDER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:949-636-0121
Mailing Address - Street 1:5601 BRODIE LN STE 530
Mailing Address - Street 2:
Mailing Address - City:SUNSET VALLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78745-2539
Mailing Address - Country:US
Mailing Address - Phone:512-358-8200
Mailing Address - Fax:512-358-0376
Practice Address - Street 1:5601 BRODIE LN STE 530
Practice Address - Street 2:
Practice Address - City:SUNSET VALLEY
Practice Address - State:TX
Practice Address - Zip Code:78745-2539
Practice Address - Country:US
Practice Address - Phone:512-358-8200
Practice Address - Fax:512-358-0376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-23
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty