Individual
DR. STANLEY NEIL BLACKMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
2009 ROOSEVELT RD, SUITE D, VALPARAISO, IN 46383-3765
(219) 462-5501
(219) 462-3238
Mailing address
2009 ROOSEVELT RD, SUITE D, VALPARAISO, IN 46383-3765
(219) 462-5501
(219) 462-3238
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18001528B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000084617
ANTHEM
IN
05
—
100150190A
—
IN
01
—
180011
UNICARE--BUDD
IN
Enumeration date
02/16/2006
Last updated
12/02/2010
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