Provider Demographics
NPI:1700880499
Name:BLANCHARD, JAIME D (OD)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:D
Last Name:BLANCHARD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7300 W GREENFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-4729
Mailing Address - Country:US
Mailing Address - Phone:414-453-6667
Mailing Address - Fax:414-774-5505
Practice Address - Street 1:7300 W GREENFIELD AVE
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-4729
Practice Address - Country:US
Practice Address - Phone:414-453-6667
Practice Address - Fax:414-774-5505
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2014-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2968-035152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38622400Medicaid
WI000347720Medicare PIN
WI38622400Medicaid
WI0299440001Medicare NSC