Individual
KIMBERLY DIANE BLANKSHAIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2015 N MAIN ST, WHEATON, IL 60187-3190
(630) 668-8250
(630) 668-8916
Mailing address
2015 N MAIN ST, WHEATON, IL 60187-3190
(630) 668-8250
(630) 668-8916
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
036155745
IL
207WX0109X
Neuro-ophthalmology Physician
Primary
036155745
IL
Other
Enumeration date
03/28/2017
Last updated
08/21/2024
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