Blaylock, Kacey Dustin
Blaylock, Kacey Dustin is an individual health care provider with primary practice located at 360 E Mallard Dr Ste 110 , Boise ID 83706-3945. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Blaylock, Kacey Dustin can be contacted via phone (208) 336-8700.Contact Information
Primary practice address
360 E Mallard Dr Ste 110
Boise ID 83706-3945
Phone: (208) 336-8700
Fax: (208) 426-0902
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | ODP-100370 | Idaho |
Profile Details
| NPI number | 1164871489 |
|---|---|
| LBN Legal business name | Blaylock, Kacey Dustin |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jun 7th, 2016 |
| Last updated | Jun 16th, 2021 - about 4 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
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