Provider Demographics
NPI:1962577247
Name:BLAIR, DORSEY C (OD)
Entity type:Individual
Prefix:DR
First Name:DORSEY
Middle Name:C
Last Name:BLAIR
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 S MASON RD
Mailing Address - Street 2:A2
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-3896
Mailing Address - Country:US
Mailing Address - Phone:281-392-9020
Mailing Address - Fax:281-392-2662
Practice Address - Street 1:830 S MASON RD
Practice Address - Street 2:A2
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-3896
Practice Address - Country:US
Practice Address - Phone:281-392-9020
Practice Address - Fax:281-392-2662
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02413TG152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered152W00000XEye and Vision Services ProvidersOptometrist
Not Answered152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT12231Medicare UPIN
TX00E26BMedicare ID - Type Unspecified