Individual
TIMOTHY BLANKENSHIP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2511 N WESTWOOD BLVD, POPLAR BLUFF, MO 63901-2338
(573) 686-5866
(573) 686-0425
Mailing address
1200 W DEYOUNG ST, MARION, IL 62959-4437
(618) 993-5686
(618) 997-6250
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2006018048
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0814870002
MEDICARE NSC NUMBER
MO
01
—
0814870015
MEDICARE NSC NUMBER
MO
01
—
0814870017
MEDICARE NSC NUMBER
MO
01
—
127205
HEALTH ALLIANCE
—
01
—
211780
ANTHEM BLUE CROSS BLUE SHIELD
MO
05
—
310865506
—
MO
01
—
MO8048
EYEMED
—
01
—
P00434357
MEDICARE RAILROAD
MO
Enumeration date
07/17/2006
Last updated
10/01/2008
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