Provider Demographics
NPI:1073210001
Name:JABLONSKI, RANDY R (LDO)
Entity Type:Individual
Prefix:
First Name:RANDY
Middle Name:R
Last Name:JABLONSKI
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3721 NAVARRE AVE
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3433
Mailing Address - Country:US
Mailing Address - Phone:419-698-8584
Mailing Address - Fax:419-698-8907
Practice Address - Street 1:3721 NAVARRE AVE
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3433
Practice Address - Country:US
Practice Address - Phone:419-698-8584
Practice Address - Fax:419-698-8907
Is Sole Proprietor?:No
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOP.013920-S156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician