MICHAEL G BLAKE

GALLUP, NM
NPI1831161264
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy152W00000X Optometrist
(Licence: NM  2241)
Additional Taxonomies152WC0802X Optometrist Corneal and Contact Management
(Licence: NM  2241)
152WL0500X Optometrist Low Vision Rehabilitation
(Licence: NM  2241)
152WS0006X Optometrist Sports Vision
(Licence: NM  2241)
152WV0400X Optometrist Vision Therapy
(Licence: NM  2241)
152WX0102X Optometrist Occupational Vision
(Licence: NM  2241)
Enumeration Date2006-02-01
Last Update Date2008-12-11
Business Address
DR. MICHAEL G BLAKE O.D.
124 W COAL AVE
GALLUP, NM 87301-6206
Phone number: 505-722-2020
Mailing Address
DR. MICHAEL G BLAKE O.D.
124 W COAL AVE
GALLUP, NM 87301-6206
Phone number: 505-722-2020