Provider Demographics
NPI:1275584484
Name:BLAHNIK, GREGORY FRANCIS (OD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:FRANCIS
Last Name:BLAHNIK
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:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33575-0039
Mailing Address - Country:US
Mailing Address - Phone:813-886-2020
Mailing Address - Fax:813-886-7222
Practice Address - Street 1:25 COLLEGE AVE W
Practice Address - Street 2:SUITE D
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-4701
Practice Address - Country:US
Practice Address - Phone:813-886-2020
Practice Address - Fax:813-886-7222
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC2487152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL078925900Medicaid
FL078925900Medicaid
U13367Medicare UPIN
20344UMedicare PIN