Provider Demographics
NPI:1548248016
Name:BLAIR, DAVID MAURICE (OD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MAURICE
Last Name:BLAIR
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 FLORENCE PIKE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:BURLINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41005-7941
Mailing Address - Country:US
Mailing Address - Phone:859-586-3937
Mailing Address - Fax:859-689-6232
Practice Address - Street 1:1821 FLORENCE PIKE
Practice Address - Street 2:SUITE 1
Practice Address - City:BURLINGTON
Practice Address - State:KY
Practice Address - Zip Code:41005-7941
Practice Address - Country:US
Practice Address - Phone:859-586-3937
Practice Address - Fax:859-689-6232
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2013-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1284DT152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7700487Medicaid
KY7700487Medicaid
K068811Medicare PIN
KYU51438Medicare UPIN