Individual
MARCIA ELLEN BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
1903 W 103RD ST, CHICAGO, IL 60643-2624
(773) 233-7799
Mailing address
10225 S OAKLEY AVE, CHICAGO, IL 60643-1915
(773) 233-3892
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046-006808
IL
152W00000X
Optometrist
1664
MN
Other
Enumeration date
11/06/2006
Last updated
07/08/2007
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