Individual
MR. TOMMIE L BLAN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
8616 N 30TH ST, OMAHA, NE 68112-1808
(402) 451-1717
(402) 451-3469
Mailing address
8616 N 30TH ST, OMAHA, NE 68112-1808
(402) 451-1717
(402) 451-3469
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017542
—
NE
05
—
10025369100
—
NE
Enumeration date
03/13/2007
Last updated
08/30/2007
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