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Individual
CHARLES RICHARD BLAKE
Active
Individual
CHARLES RICHARD BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
29828
SC
207W00000X
Ophthalmology Physician
Primary
ME90057
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010129300
—
FL
01
—
0800815
UNITED HEALTHCARE
NC
01
—
141A6
BCBS NC
NC
01
—
183075
MEDCOST
NC
01
—
32840
OPTICARE
NC
05
—
5902230
—
NC
01
—
7273542
AETNA
NC
01
—
806940
COMMUNITY EYE CARE
NC
05
—
GP4696
—
SC
01
—
OPH174
PRIMAHEALTH
NC
Enumeration date
08/02/2005
Last updated
06/01/2020
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