Provider Demographics
NPI:1932133600
Name:BLAYLOCK, WEISHING CYNTHIA (OD)
Entity Type:Individual
Prefix:DR
First Name:WEISHING
Middle Name:CYNTHIA
Last Name:BLAYLOCK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:WEISHING
Other - Middle Name:CYNTHIA
Other - Last Name:CHAO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5815 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1524
Mailing Address - Country:US
Mailing Address - Phone:317-985-6420
Mailing Address - Fax:
Practice Address - Street 1:1955 MONUMENT BLVD
Practice Address - Street 2:SUITE 4-A
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-3873
Practice Address - Country:US
Practice Address - Phone:925-326-0120
Practice Address - Fax:925-326-3120
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2016-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18003304A152W00000X
CA14513152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200529580Medicaid
INV01089Medicare UPIN
IN439420JMedicare ID - Type Unspecified