1235341116 NPI number — DR. CHRISTINE Y BLICK OD

Table of content: DR. CHRISTINE Y BLICK OD (NPI 1235341116)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235341116 NPI number — DR. CHRISTINE Y BLICK OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLICK
Provider First Name:
CHRISTINE
Provider Middle Name:
Y
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1235341116
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/05/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
502 CELEBRATION AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CELEBRATION
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34747-4687
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
407-566-8505
Provider Business Mailing Address Fax Number:
407-566-8253

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
502 CELEBRATION AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CELEBRATION
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34747-4687
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-566-8585
Provider Business Practice Location Address Fax Number:
407-566-8253
Provider Enumeration Date:
05/04/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  OPC 3431 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152WC0802X , with the licence number: OPC 3431 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)