Bush, Blake Robert

Bush, Blake Robert is an sole proprietor health care provider with primary practice located at 908 N Rockford Rd Suite E, Ardmore OK 73401-2540. He recently has 7 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 / Pediatrics, 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. Bush, Blake Robert can be contacted via phone (580) 223-7333.

Contact Information

Primary practice address
908 N Rockford Rd Suite E Ardmore OK 73401-2540
Fax: (580) 319-4411
Website:

Profile Details

NPI number 1235395542
LBN Legal business name Bush, Blake Robert
Credentials Doctor of Optometry (OD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 6th, 2008
Last updated May 12th, 2015 - about 9 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 1235395542 NPPES
Oklahoma MEDICAID 200205700A

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