Individual
KACEY DUSTIN BLAYLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
360 E MALLARD DR STE 110, BOISE, ID 83706-3945
(208) 336-8700
(208) 426-0902
Mailing address
360 E MALLARD DR STE 110, BOISE, ID 83706-3945
(208) 336-8700
(208) 426-0902
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
ODP-100370
ID
Other
Enumeration date
06/07/2016
Last updated
06/16/2021
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