Individual
MARK ALLAN BLACKLEDGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
5107 N BELT HWY STE Y107, SAINT JOSEPH, MO 64506-1280
(308) 530-6666
Mailing address
5107 N BELT HWY STE Y107, SAINT JOSEPH, MO 64506-1280
(308) 530-6666
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
2015007758
MO
152W00000X
Optometrist
953
NE
Other
Enumeration date
05/05/2006
Last updated
03/12/2018
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