Provider Demographics
NPI:1447491998
Name:BLANSETT, DEBORAH KELLER (OD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:KELLER
Last Name:BLANSETT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MS
Other - First Name:DEBORAH
Other - Middle Name:ANN
Other - Last Name:KELLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5246 HWY 377 S.
Mailing Address - Street 2:SUITE 1
Mailing Address - City:KRUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76227
Mailing Address - Country:US
Mailing Address - Phone:940-365-0440
Mailing Address - Fax:940-365-0131
Practice Address - Street 1:5246 HWY 377 S.
Practice Address - Street 2:SUITE 1
Practice Address - City:KRUGERVILLE
Practice Address - State:TX
Practice Address - Zip Code:76227
Practice Address - Country:US
Practice Address - Phone:940-365-0440
Practice Address - Fax:940-365-0131
Is Sole Proprietor?:No
Enumeration Date:2009-03-13
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6359T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
U73009Medicare UPIN