Individual provider · NPI-1
Richard Gary Blake, R.D.O.
Technician/Technologist, Optician · Woodland Hills, CA
NPI number1174650071
StatusActive
Last updated in NPPESJul 8, 2007
Details
- NPI
- 1174650071
- Entity type
- Individual (NPI-1)
- Name
- Mr. Richard Gary Blake
- Credential
- R.D.O.
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Feb 27, 2007
- Last updated
- Jul 8, 2007
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 156FX1800X | Technician/Technologist, Optician | D006638 | CA | Yes |
Practice location
21835 Ventura BlvdWoodland Hills, CA 91364-1838
Phone 818-883-9567 · Fax 818-883-5261
Mailing address
1086 Deep Wood DrWestlake Village, CA 91362-4215
Phone 805-495-4046 · Fax 808-883-5261
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