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
Phone: (580) 223-7333
Fax: (580) 319-4411
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Eye and Vision Services Providers / Optometrist | 152W00000X | 2550 | Oklahoma |
Eye and Vision Services Providers / Corneal and Contact Management | 152WC0802X | 2550 | Oklahoma |
Eye and Vision Services Providers / Low Vision Rehabilitation | 152WL0500X | 2550 | Oklahoma |
Eye and Vision Services Providers / Pediatrics | 152WP0200X | 2550 | Oklahoma |
Eye and Vision Services Providers / Sports Vision | 152WS0006X | 2550 | Oklahoma |
Eye and Vision Services Providers / Vision Therapy | 152WV0400X | 2550 | Oklahoma |
Eye and Vision Services Providers / Occupational Vision | 152WX0102X | 2550 | Oklahoma |
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.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1235395542 | NPPES |
Oklahoma | MEDICAID | 200205700A |
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