Provider Demographics
NPI:1366556300
Name:BLASKOVICH, KATHERINE ANNE (OD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:ANNE
Last Name:BLASKOVICH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:7027 N SCOTTSDALE RD
Mailing Address - Street 2:149
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-3682
Mailing Address - Country:US
Mailing Address - Phone:219-793-3946
Mailing Address - Fax:
Practice Address - Street 1:8752 E SHEA BLVD
Practice Address - Street 2:SUITE 125
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-6640
Practice Address - Country:US
Practice Address - Phone:480-991-6432
Practice Address - Fax:480-991-2143
Is Sole Proprietor?:No
Enumeration Date:2006-08-18
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18002741152W00000X
AZ1562152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist