Blostica, Lynnette Raye
Blostica, Lynnette Raye is an individual health care provider with primary practice located at 3412 W Centre Ave , Portage MI 49024-4624. She recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as her primary health care specialty. Blostica, Lynnette Raye can be contacted via phone (269) 329-5860.Contact Information
Primary practice address
3412 W Centre Ave
Portage MI 49024-4624
Phone: (269) 329-5860
Fax: (269) 329-5865
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | 4901004446 | Michigan |
Profile Details
| NPI number | 1053524884 |
|---|---|
| LBN Legal business name | Blostica, Lynnette Raye |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 8th, 2007 |
| Last updated | Nov 17th, 2022 - 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1053524884 | NPPES |
| Michigan | MEDICAID | 945215713 |
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