Provider Demographics
NPI:1912163452
Name:BLAHNIK VISION CENTER
Entity Type:Organization
Organization Name:BLAHNIK VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:M
Authorized Official - Last Name:BLAHNIK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:504-361-4446
Mailing Address - Street 1:93 TERRY PKWY
Mailing Address - Street 2:SUITE 9
Mailing Address - City:TERRYTOWN
Mailing Address - State:LA
Mailing Address - Zip Code:70056-5502
Mailing Address - Country:US
Mailing Address - Phone:504-361-4446
Mailing Address - Fax:
Practice Address - Street 1:93 TERRY PKWY
Practice Address - Street 2:SUITE 9
Practice Address - City:TERRYTOWN
Practice Address - State:LA
Practice Address - Zip Code:70056-5502
Practice Address - Country:US
Practice Address - Phone:504-361-4446
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-04
Last Update Date:2008-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA931158T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA5CR32Medicare PIN