Provider Demographics
NPI:1811926587
Name:BLADES, KURT E (OD)
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:E
Last Name:BLADES
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:PO BOX 1368
Mailing Address - Street 2:
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-1368
Mailing Address - Country:US
Mailing Address - Phone:406-862-2020
Mailing Address - Fax:406-862-2385
Practice Address - Street 1:346 CENTRAL AVE STE B
Practice Address - Street 2:
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-2664
Practice Address - Country:US
Practice Address - Phone:406-862-2020
Practice Address - Fax:406-862-2385
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT517152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT04-83378Medicaid
MT25149Medicare ID - Type UnspecifiedMEDICARE #
MT04-83378Medicaid