Provider Demographics
NPI:1407017007
Name:BARRY D. BLONDER O.D., P.C.
Entity type:Organization
Organization Name:BARRY D. BLONDER O.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE SECRETARY
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACQUE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLONDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:520-790-7498
Mailing Address - Street 1:6163 E BROADWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-4028
Mailing Address - Country:US
Mailing Address - Phone:520-790-7498
Mailing Address - Fax:520-790-1311
Practice Address - Street 1:6159 E BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-4028
Practice Address - Country:US
Practice Address - Phone:520-790-2020
Practice Address - Fax:520-790-8328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-17
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ19152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty