Provider Demographics
NPI:1407046451
Name:BLAKE A HOUSLER OD INC
Entity type:Organization
Organization Name:BLAKE A HOUSLER OD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:A
Authorized Official - Last Name:HOUSLER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:814-837-7880
Mailing Address - Street 1:175 N FRALEY ST
Mailing Address - Street 2:
Mailing Address - City:KANE
Mailing Address - State:PA
Mailing Address - Zip Code:16735-1164
Mailing Address - Country:US
Mailing Address - Phone:814-837-7880
Mailing Address - Fax:814-837-0883
Practice Address - Street 1:175 N FRALEY ST
Practice Address - Street 2:
Practice Address - City:KANE
Practice Address - State:PA
Practice Address - Zip Code:16735-1164
Practice Address - Country:US
Practice Address - Phone:814-837-7880
Practice Address - Fax:814-837-0883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-26
Last Update Date:2019-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG000844152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0496620001Medicare NSC
PAT27602Medicare UPIN
PA049565Medicare PIN