NPI 1831161264 · live from the CMS NPI Registry
Michael G Blake, O.D.
Optometrist in Gallup, NM. National Provider Identifier 1831161264, active.
NPI record
| NPI | 1831161264 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Optometrist 152W00000X |
| Practice location | 124 W Coal Ave, Gallup, NM 87301 |
| Practice phone | 505-722-2020 |
| Enumerated | February 1, 2006 |
| Last updated | December 11, 2008 |
| Sole proprietor | No |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Optometrist primary | 152W00000X | 2241 (NM) |
| Optometrist, Corneal and Contact Management | 152WC0802X | 2241 (NM) |
| Optometrist, Low Vision Rehabilitation | 152WL0500X | 2241 (NM) |
| Optometrist, Sports Vision | 152WS0006X | 2241 (NM) |
| Optometrist, Vision Therapy | 152WV0400X | 2241 (NM) |
| Optometrist, Occupational Vision | 152WX0102X | 2241 (NM) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.