Provider Demographics
NPI:1801199013
Name:BLANTON, JOSHUA LEE (OD)
Entity type:Individual
Prefix:DR
First Name:JOSHUA
Middle Name:LEE
Last Name:BLANTON
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 1:335 E PARKER RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTON
Mailing Address - State:NC
Mailing Address - Zip Code:28655-5112
Mailing Address - Country:US
Mailing Address - Phone:828-433-1000
Mailing Address - Fax:
Practice Address - Street 1:335 E PARKER RD
Practice Address - Street 2:
Practice Address - City:MORGANTON
Practice Address - State:NC
Practice Address - Zip Code:28655-5112
Practice Address - Country:US
Practice Address - Phone:828-433-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-09
Last Update Date:2017-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2219152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC16363OtherBLUE CROSS BLUE SHIELD NORTH CAROLINA
NC5918106Medicaid
NC16363OtherBLUE CROSS BLUE SHIELD NORTH CAROLINA
NCNC0208AMedicare PIN