Individual
CHARLES RICHARD BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1600 SW ARCHER RD, GAINESVILLE, FL 32610-0371
(352) 392-3451
Mailing address
PO BOX 100284, GAINESVILLE, FL 32610-0284
(352) 273-8778
(352) 273-7402
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
29828
SC
207W00000X
Ophthalmology Physician
Primary
ME90057
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010129300
—
FL
01
—
0800815
UNITED HEALTHCARE
NC
01
—
141A6
BCBS NC
NC
01
—
183075
MEDCOST
NC
01
—
32840
OPTICARE
NC
05
—
5902230
—
NC
01
—
7273542
AETNA
NC
01
—
806940
COMMUNITY EYE CARE
NC
05
—
GP4696
—
SC
01
—
OPH174
PRIMAHEALTH
NC
Enumeration date
08/02/2005
Last updated
06/01/2020
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