Organization
DR. TAYLOR BLADH, O.D., INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TAYLOR WOODBURY BLADH O.D. (PRESIDENT/ OPTOMETRIST)
(909) 861-3737
Entity
Organization
Contact information
Practice address
718 N. DIAMOND BAR BLVD, DIAMOND BAR, CA 91765-4122
(909) 861-3737
(909) 396-7517
Mailing address
718 N. DIAMOND BAR BLVD., DIAMOND BAR, CA 91765-4122
(909) 861-3737
(909) 396-7517
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GSD000650
—
CA
Enumeration date
11/21/2006
Last updated
07/03/2012
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