Individual
BLAKE CHURCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
16800 W CLEVELAND AVE, NEW BERLIN, WI 53151-3533
(414) 313-7121
Mailing address
16800 W CLEVELAND AVE, NEW BERLIN, WI 53151-3533
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4089-35
WI
Other
Enumeration date
07/09/2025
Last updated
08/03/2025
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