Provider Demographics
NPI:1356606396
Name:STUART BLANKMAN OPTOMETRIST PC
Entity type:Organization
Organization Name:STUART BLANKMAN OPTOMETRIST PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:HARVEY
Authorized Official - Last Name:BLANKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:212-362-8090
Mailing Address - Street 1:2472 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-7449
Mailing Address - Country:US
Mailing Address - Phone:212-362-8090
Mailing Address - Fax:212-857-1488
Practice Address - Street 1:2472 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-7449
Practice Address - Country:US
Practice Address - Phone:212-362-8090
Practice Address - Fax:212-875-1488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-05
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV0026301152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA100082517Medicare PIN