Organization
JOHN C BLACKENBURG OD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN C BLACKENBURG OD (OWNER)
(251) 645-2991
Entity
Organization
Contact information
Practice address
7930 MOFFETT RD, SEMMES, AL 36575-5490
(251) 645-2991
(251) 645-0723
Mailing address
7930 MOFFETT RD, SEMMES, AL 36575-5490
(251) 645-2991
(251) 645-0723
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
S498TA014
AL
Other
Enumeration date
03/09/2010
Last updated
08/03/2010
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