Individual
DR. JAMES ERVIN BLUME
Inactive
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
5917 STONEY CREEK DR, FORT WAYNE, IN 46825-4401
(260) 482-8435
Mailing address
5917 STONEY CREEK DR, FORT WAYNE, IN 46825-4401
(260) 482-8435
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
18001661B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100385090A
—
IN
01
—
4164020001
NATIONAL SUPPLIER CLEARINGHOUSE
—
Enumeration date
07/11/2005
Last updated
02/11/2009
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