Provider Demographics
NPI:1679629588
Name:BLINK OPTOMETRY, A PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:BLINK OPTOMETRY, A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:WENDY
Authorized Official - Middle Name:U
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:949-581-8222
Mailing Address - Street 1:22972 MOULTON PKWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-1219
Mailing Address - Country:US
Mailing Address - Phone:949-581-8222
Mailing Address - Fax:949-581-8223
Practice Address - Street 1:22972 MOULTON PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-1219
Practice Address - Country:US
Practice Address - Phone:949-581-8222
Practice Address - Fax:949-581-8223
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty