Kacey Dustin Blaylock, O.D.

NPI #1164871489 in Boise, Idaho

Provider Information

NPI Number: 1164871489
Entity Type: Individual
Name: Kacey Dustin Blaylock, O.D.
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Optometrist
Credential: O.D.
Enumeration Date: Jun 7, 2016
Last Updated: Jun 16, 2021

Practice Location

Address: 360 E MALLARD DR STE 110
City: Boise
State: Idaho
ZIP Code: 83706-3945
Phone: (208) 336-8700

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Optometrist	152W00000X	Primary

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