Provider Demographics
NPI:1295784494
Name:BLASCO, JAMES A (OD)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:A
Last Name:BLASCO
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 1:2566 HUBBELL AVE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50317
Mailing Address - Country:US
Mailing Address - Phone:515-262-1094
Mailing Address - Fax:515-262-2610
Practice Address - Street 1:2566 HUBBELL AVE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50317
Practice Address - Country:US
Practice Address - Phone:515-262-1094
Practice Address - Fax:515-262-2610
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2008-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01842152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA6038091Medicaid
IA3038091Medicaid
IA5038091Medicaid
IA7038091Medicaid
T65198Medicare UPIN
IA3038091Medicaid
27925Medicare PIN
IA7038091Medicaid
IA6038091Medicaid
410029169Medicare PIN
410026944Medicare PIN
27926Medicare PIN
410029170Medicare PIN