Organization
DR GARY L BLACKMAN OPTOMETRIST, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY L BLACKMAN OD (OWNER)
(217) 553-7709
Entity
Organization
Contact information
Practice address
16 MADERA CT, TAYLORVILLE, IL 62568-8927
(217) 553-7709
Mailing address
16 MADERA CT, TAYLORVILLE, IL 62568-8927
(217) 553-7709
(217) 303-5424
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Enumeration date
12/20/2011
Last updated
10/06/2012
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