Organization
STANLEY N. BLACKMAN, O.D., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. STANLEY N BLACKMAN O.D. (OWNER)
(219) 462-5501
Entity
Organization
Contact information
Practice address
2009 ROOSEVELT RD, SUITE D, VALPARAISO, IN 46383-3765
(219) 462-5501
(219) 462-3238
Mailing address
2009 ROOSEVELT RD, SUITE D, VALPARAISO, IN 46383-3765
(219) 462-5501
(219) 462-3238
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18001528B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000084617
ANTHEM
IN
01
—
1518931310
NPI INDIVIDUAL
IN
Enumeration date
08/20/2007
Last updated
08/20/2007
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