Provider Demographics
NPI:1831555010
Name:BLAKE, STEVEN (OD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:
Last Name:BLAKE
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 1:3199 E 2890 S
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-1329
Mailing Address - Country:US
Mailing Address - Phone:435-633-3256
Mailing Address - Fax:
Practice Address - Street 1:2557 S RIVER ROAD
Practice Address - Street 2:#B3
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-1329
Practice Address - Country:US
Practice Address - Phone:435-633-3256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-04
Last Update Date:2024-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5927476-9934152WC0802X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X, 152W00000X, 152WS0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision