Organization
KENNY R BLACKSTON OD PC
Active
Other names
Blackston Quality Eye Care
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. STEPHANIE BLACKSTON (OFFICE MANAGER)
(334) 222-6325
Entity
Organization
Contact information
Practice address
1306 RIVER FALLS ST, ANDALUSIA, AL 36421-2081
(334) 222-6325
Mailing address
PO BOX 638, ANDALUSIA, AL 36420-1212
(334) 222-6325
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
S-950-TA-529
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009943415
—
AL
01
—
0515-19208
BLUE CROSS
AL
Enumeration date
02/12/2007
Last updated
08/26/2024
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