Provider Demographics
NPI:1194925222
Name:DR BLACKS OPTOMETRY PC
Entity type:Organization
Organization Name:DR BLACKS OPTOMETRY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIC ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:TROTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-299-3937
Mailing Address - Street 1:4424 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47802-4304
Mailing Address - Country:US
Mailing Address - Phone:812-299-3937
Mailing Address - Fax:812-299-8670
Practice Address - Street 1:4424 S 7TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4304
Practice Address - Country:US
Practice Address - Phone:812-299-3937
Practice Address - Fax:812-299-8670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-18
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100251270AMedicaid
IN201023600AMedicaid
IN100251270AMedicaid
IN201023600AMedicaid
IN5949580001Medicare NSC
INDF9692Medicare PIN