Individual
JENNIFER BLAKEMORE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
10791 BELLEVILLE RD, VAN BUREN TWP, MI 48111
(734) 391-3080
(734) 345-5901
Mailing address
118 CASS AVE, MOUNT CLEMENS, MI 48043-2204
(586) 468-7370
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4901005135
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1699267278
—
MI
Enumeration date
05/31/2018
Last updated
06/27/2018
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