Organization
MICHAEL G BLAKE AND ASSOCIATES INC.
Active
Other names
Gallup Vision Source
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL G BLAKE O.D. (OPTOMETRIST)
(505) 722-2020
Entity
Organization
Contact information
Practice address
124 W COAL AVE, GALLUP, NM 87301-6206
(505) 722-2020
(505) 863-2204
Mailing address
124 WEST COAL AVE, GALLUP, NM 87301
(505) 722-2020
(505) 863-2204
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NM00O520
BLUE CROSS BLUE SHIELD NM
NM
Enumeration date
12/16/2008
Last updated
12/16/2008
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