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Contact Information

MICHAEL G BLAKE, OD
124 W COAL AVE
GALLUP, NM87301-6206
 Phone: 505-722-2020
 Fax: 505-863-2204
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
 

Corneal and Contact Management

152WC0802X 41 Optometry
 

Low Vision Rehabilitation

152WL0500X 41 Optometry
 

Occupational Vision

152WX0102X 41 Optometry
 

Sports Vision

152WS0006X 41 Optometry
 

Vision Therapy

152WV0400X 41 Optometry
Indicates primary specialty

NPI Profile & details for MICHAEL G BLAKE · (Male)

NPI # 1831161264
Status Active
Credentials OD (Doctor of Optometry)
Entity Individual
Enumeration date 02/01/2006
Last updated 12/11/2008 - About 17 years ago
Sole proprietor 1 No
Identifiers
  • NM License # 2241
  • NM Other NM00O520 BLUE CROSS BLUE SHIELD NM
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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