Individual
DR. JOHN SCOTT BLASE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
9250 FM 78, CONVERSE, TX 78109-2903
(210) 659-1223
(210) 659-2924
Mailing address
9250 FM 78, CONVERSE, TX 78109-2903
(210) 659-1223
(210) 659-2924
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2335TG
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00E75A
MEDICARE PTAN
TX
05
—
0933889-01
—
TX
01
—
742006921
TRICARE
TX
01
—
909816
AETNA MED.
TX
Enumeration date
11/27/2006
Last updated
07/21/2011
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