Provider Demographics
NPI:1932223849
Name:BLINSTRUP, MICHAEL J (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:BLINSTRUP
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:136 W LAKE ST
Mailing Address - Street 2:STE 110
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1020
Mailing Address - Country:US
Mailing Address - Phone:630-980-9095
Mailing Address - Fax:630-980-9156
Practice Address - Street 1:136 W LAKE ST
Practice Address - Street 2:STE 110
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1020
Practice Address - Country:US
Practice Address - Phone:630-980-9095
Practice Address - Fax:630-980-9156
Is Sole Proprietor?:No
Enumeration Date:2007-03-17
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist