Blissenbach, David A

Blissenbach, David A is an individual health care provider with primary practice located at 100 N 8Th St , E St Louis IL 62201-2989. He recently has only one registered license in Eye and Vision Services Providers / Optician, which is considered as his primary health care specialty. Blissenbach, David A can be contacted via phone (618) 274-2020.

Contact Information

Primary practice address
100 N 8Th St E St Louis IL 62201-2989
Phone: (618) 274-2020
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Eye and Vision Services Providers / Optician 156FX1800X

Profile Details

NPI number 1407895014
LBN Legal business name Blissenbach, David A
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 6th, 2006
Last updated Jul 9th, 2007 - about 17 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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1407895014 NPPES
Illinois MEDICAID 371210755001

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