Provider Demographics
NPI:1043265267
Name:BLENKER, JULIE M (OD)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:M
Last Name:BLENKER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7244 CRANE DR
Mailing Address - Street 2:
Mailing Address - City:LINO LAKES
Mailing Address - State:MN
Mailing Address - Zip Code:55038-4701
Mailing Address - Country:US
Mailing Address - Phone:763-292-0101
Mailing Address - Fax:651-788-9695
Practice Address - Street 1:261 RUTH ST N STE E
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55119-4337
Practice Address - Country:US
Practice Address - Phone:651-739-5173
Practice Address - Fax:651-739-8907
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2023-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2652-035152W00000X
MN2573152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI38619800Medicaid
WI000787845Medicare ID - Type Unspecified
WI38619800Medicaid