Blake, Michael G
Blake, Michael G is an individual health care provider with primary practice located at 124 W Coal Ave , Gallup NM 87301-6206. He recently has 6 registered licenses in different health care specialties including Eye and Vision Services Providers / Optometrist, Eye and Vision Services Providers / Corneal and Contact Management, Eye and Vision Services Providers / Low Vision Rehabilitation, Eye and Vision Services Providers / Sports Vision, Eye and Vision Services Providers / Vision Therapy, Eye and Vision Services Providers / Occupational Vision. Eye and Vision Services Providers / Optometrist is his primary health care specialty. Blake, Michael G can be contacted via phone (505) 722-2020.Contact Information
Primary practice address
124 W Coal Ave
Gallup NM 87301-6206
Phone: (505) 722-2020
Fax: (505) 863-2204
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Eye and Vision Services Providers / Optometrist | 152W00000X | 2241 | New Mexico |
Eye and Vision Services Providers / Corneal and Contact Management | 152WC0802X | 2241 | New Mexico |
Eye and Vision Services Providers / Low Vision Rehabilitation | 152WL0500X | 2241 | New Mexico |
Eye and Vision Services Providers / Sports Vision | 152WS0006X | 2241 | New Mexico |
Eye and Vision Services Providers / Vision Therapy | 152WV0400X | 2241 | New Mexico |
Eye and Vision Services Providers / Occupational Vision | 152WX0102X | 2241 | New Mexico |
Profile Details
NPI number | 1831161264 |
---|---|
LBN Legal business name | Blake, Michael G |
Credentials | Doctor of Optometry (OD) |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Feb 1st, 2006 |
Last updated | Dec 11th, 2008 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1831161264 | NPPES |
New Mexico | Other | NM00O520 | BLUE CROSS BLUE SHIELD NM |
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