Organization
MARCIA E. BLAKE, O.D.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARCIA E. BLAKE O.D. (OWNER)
(773) 233-7799
Entity
Organization
Contact information
Practice address
1903 W 103RD ST, CHICAGO, IL 60643-2624
(773) 233-7799
(773) 233-6362
Mailing address
1903 W 103RD ST, CHICAGO, IL 60643-2624
(773) 233-7799
(773) 233-6362
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
046-006808
IL
Other
Enumeration date
03/27/2014
Last updated
03/27/2014
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