Individual
DR. WALTER B BLANKENSHIP
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
126 JEFFERSON ST, MANSFIELD, LA 71052-2602
(318) 872-0747
(318) 872-0748
Mailing address
10485 LONGFELLOW TRCE, SHREVEPORT, LA 71106-9383
(318) 524-1545
(318) 872-0748
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
668 107T
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1072087
—
LA
Enumeration date
07/29/2006
Last updated
07/08/2007
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