Provider Demographics
NPI:1356578116
Name:BLEHM, AARON RAY (OD)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:RAY
Last Name:BLEHM
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 1:201 E LAUREL BLVD
Mailing Address - Street 2:
Mailing Address - City:POTTSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17901-2534
Mailing Address - Country:US
Mailing Address - Phone:570-628-4444
Mailing Address - Fax:570-628-3088
Practice Address - Street 1:201 E LAUREL BLVD
Practice Address - Street 2:
Practice Address - City:POTTSVILLE
Practice Address - State:PA
Practice Address - Zip Code:17901-2534
Practice Address - Country:US
Practice Address - Phone:570-628-4444
Practice Address - Fax:570-628-3088
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002188152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA455039203OtherTAX ID OF GROUP
PA232413259OtherTAX ID OF GROUP
PA102381606Medicaid
PA102381606Medicaid
PA163061KHMMedicare PIN