Individual
MR. FREDERICK DONALD BLANK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2512 CLARK AVE, CLEVELAND, OH 44109-1111
(216) 241-2040
Mailing address
2512 CLARK AVE, CLEVELAND, OH 44109-1111
(216) 241-2040
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
#2856
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0248084
—
OH
Enumeration date
02/06/2007
Last updated
07/08/2007
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