Organization
DR. TAYLOR BLADH O.D. INC
Active
Parent organization
DR. TAYLOR BLADH O.D. INC
Other names
Newport Harbor Optometry
Organization subpart
Yes
Provider details
NPI number
Legal business name
DR. TAYLOR BLADH O.D. INC
Authorized official
DR. TAYLOR WOODBURY BLADH OD (PRESIDENT)
(909) 861-3737
Entity
Organization
Contact information
Practice address
1796 NEWPORT BLVD, COSTA MESA, CA 92627-2756
(949) 642-2020
(949) 642-8753
Mailing address
1796 NEWPORT BLVD, COSTA MESA, CA 92627-2756
(949) 642-2020
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
152WC0802X
Corneal and Contact Management Optometrist
—
—
152WP0200X
Pediatric Optometrist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OPT8921TPA
OPTOMETRY LICENSE NUMBER
CA
Enumeration date
04/25/2019
Last updated
06/11/2019
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