Provider Demographics
NPI:1245308253
Name:BRANDON A. BLAIR, O.D., P.C.
Entity type:Organization
Organization Name:BRANDON A. BLAIR, O.D., P.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLAIR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:308-728-3229
Mailing Address - Street 1:1511 M ST
Mailing Address - Street 2:
Mailing Address - City:ORD
Mailing Address - State:NE
Mailing Address - Zip Code:68862-1428
Mailing Address - Country:US
Mailing Address - Phone:308-729-3229
Mailing Address - Fax:308-728-5908
Practice Address - Street 1:1511 M ST
Practice Address - Street 2:
Practice Address - City:ORD
Practice Address - State:NE
Practice Address - Zip Code:68862-1428
Practice Address - Country:US
Practice Address - Phone:308-729-3229
Practice Address - Fax:308-728-5908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE410044452OtherRAILROAD MEDICARE
NE410026405OtherRAIL ROAD MEDICARE
NE=========02Medicaid
NE=========02Medicaid
NE410044452OtherRAILROAD MEDICARE