Provider Demographics
NPI:1023144938
Name:SAM R SILVERBLATT, OD APMC
Entity type:Organization
Organization Name:SAM R SILVERBLATT, OD APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:SILVERBLATT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:318-798-4000
Mailing Address - Street 1:1803 E 70TH ST
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-5301
Mailing Address - Country:US
Mailing Address - Phone:318-798-4000
Mailing Address - Fax:318-798-4001
Practice Address - Street 1:1803 E 70TH ST
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-5301
Practice Address - Country:US
Practice Address - Phone:318-798-4000
Practice Address - Fax:318-798-4001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA90086T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAT19631Medicare UPIN
LA0589980001Medicare NSC
LA49244Medicare ID - Type Unspecified