Provider Demographics
NPI:1457594442
Name:JASON D. BLANKENSHIP & ASSOCIATES, P.C.
Entity Type:Organization
Organization Name:JASON D. BLANKENSHIP & ASSOCIATES, P.C.
Other - Org Name:BUCKHEAD EYE CARE AND OPTIQUE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:BLANKENSHIP
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:404-367-0682
Mailing Address - Street 1:2277 PEACHTREE RD NE
Mailing Address - Street 2:SUITE C
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30309-1168
Mailing Address - Country:US
Mailing Address - Phone:404-367-0682
Mailing Address - Fax:404-367-9297
Practice Address - Street 1:2277 PEACHTREE RD NE
Practice Address - Street 2:SUITE C
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30309-1168
Practice Address - Country:US
Practice Address - Phone:404-367-0682
Practice Address - Fax:404-367-9297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT002308261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care