Provider Demographics
NPI:1538567243
Name:BLINK EYECARE, PLLC
Entity type:Organization
Organization Name:BLINK EYECARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALIISA
Authorized Official - Middle Name:
Authorized Official - Last Name:BODKER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:734-725-2020
Mailing Address - Street 1:7960 HALLIE CT
Mailing Address - Street 2:
Mailing Address - City:SUPERIOR TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48198-7605
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:108 N. RIDGE RD
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48187-6678
Practice Address - Country:US
Practice Address - Phone:734-725-2020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-11
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004376152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty