Provider Demographics
NPI:1801912845
Name:BLANKENSHIP, DOUGLAS ALAN (OD)
Entity type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:ALAN
Last Name:BLANKENSHIP
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:15700 LEXINGTON BLVD APT 509
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-4165
Mailing Address - Country:US
Mailing Address - Phone:281-491-4338
Mailing Address - Fax:
Practice Address - Street 1:5660 W GRAND PKWY S
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-5880
Practice Address - Country:US
Practice Address - Phone:832-595-2446
Practice Address - Fax:832-595-2446
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6735TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist