NPI 1245929140 · live from the CMS NPI Registry
Samantha Ann Blanke, OD
Optometrist in Ft Mitchell, KY. National Provider Identifier 1245929140, active.
NPI record
| NPI | 1245929140 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Optometrist 152W00000X |
| Practice location | 2174 Dixie Hwy, Ft Mitchell, KY 41017 |
| Practice phone | 859-341-2566 |
| Mailing address | 3405 Woodland Dr, Manitowoc, WI 54220 |
| Enumerated | May 5, 2023 |
| Last updated | July 18, 2024 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | — |
| Optometrist primary | 152W00000X | ATI4665 (OR) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.