Provider Demographics
NPI:1255319190
Name:BLYSKAL, STANLEY JOHN (OD)
Entity Type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:JOHN
Last Name:BLYSKAL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 W WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07882-2121
Mailing Address - Country:US
Mailing Address - Phone:908-689-1214
Mailing Address - Fax:908-689-2960
Practice Address - Street 1:123 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:NJ
Practice Address - Zip Code:07882-2121
Practice Address - Country:US
Practice Address - Phone:908-689-1214
Practice Address - Fax:908-689-2960
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ2807152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJN27503Medicare UPIN
NJ450731Medicare ID - Type Unspecified