Individual
DR. JOHN C. BLACKENBURG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
700 DALLAS AVE, SELMA, AL 36701-5451
(850) 622-0364
(850) 622-0364
Mailing address
2080 OLDE TOWNE AVE, MIRAMAR BEACH, FL 32550-6500
(850) 622-0364
(850) 622-0364
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
S498-TA014
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
528200370
—
AL
Enumeration date
07/03/2006
Last updated
07/08/2007
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