Individual
DR. BLAKE THOMAS DIRKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
320 SUNRISE DR, SAINT PETER, MN 56082-1352
(507) 931-6436
(507) 934-9625
Mailing address
320 SUNRISE DR, SAINT PETER, MN 56082-1352
(507) 931-6436
(507) 934-9625
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2076
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0322460001
DMERC
—
01
—
0582866
IOWA MA
—
01
—
1001626
PREFERRED ONE
—
01
—
114330
UCARE
MN
01
—
1D065DI
BCBS
MN
01
—
21 16066
EYEWEAR MEDICA
—
01
—
22 12052
MEDICA
—
05
—
228223200
—
MN
01
—
410005042
RAILROAD MEDICARE
—
01
—
44977TH
BLUE PLUS EYEWEAR
—
01
—
HP28649
HEALTH PARTNERS
MN
Enumeration date
11/29/2006
Last updated
02/14/2014
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