Individual
MR. BLAINE MICHAEL THORP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
712 CAMERON WOODS DR, ANGOLA, IN 46703-8816
(260) 665-3240
Mailing address
1236 QUIET HARBOR DR, FREMONT, IN 46737-7500
(419) 356-3210
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18004347A
IN
Other
Enumeration date
07/20/2022
Last updated
07/20/2022
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