Provider Demographics
NPI:1487716395
Name:BLUMENSTOCK, BRADLEY J (OD)
Entity type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:J
Last Name:BLUMENSTOCK
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1501 PINE LAKE RD STE 1
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68512-3692
Mailing Address - Country:US
Mailing Address - Phone:402-421-7773
Mailing Address - Fax:402-421-7859
Practice Address - Street 1:1501 PINE LAKE RD STE 1
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68512-3692
Practice Address - Country:US
Practice Address - Phone:402-421-7773
Practice Address - Fax:402-421-7859
Is Sole Proprietor?:No
Enumeration Date:2006-12-15
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE1106152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
252344OtherMIDLANDS CHOICE
NE37050OtherBCBS
NE47082765800Medicaid
U74017Medicare UPIN
NE47082765800Medicaid
NE1317090001Medicare NSC