Provider Demographics
NPI:1205909447
Name:HORIO, BLAKE H (MD)
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:H
Last Name:HORIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 N WABASH AVE UNIT 77F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3979
Mailing Address - Country:US
Mailing Address - Phone:630-269-1459
Mailing Address - Fax:
Practice Address - Street 1:401 N WABASH AVE UNIT 77F
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3979
Practice Address - Country:US
Practice Address - Phone:630-269-1459
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036090898208600000X, 207WX0107X
IL036-090898207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No208600000XAllopathic & Osteopathic PhysiciansSurgery
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G10376Medicare UPIN