Provider Demographics
NPI:1275655417
Name:RICHARD A. JABLONSKI, DO PA
Entity Type:Organization
Organization Name:RICHARD A. JABLONSKI, DO PA
Other - Org Name:ORMOND EYE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:JABLONSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:386-673-3345
Mailing Address - Street 1:1425 HAND AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-1135
Mailing Address - Country:US
Mailing Address - Phone:386-673-3345
Mailing Address - Fax:386-672-1854
Practice Address - Street 1:1425 HAND AVE
Practice Address - Street 2:SUITE A
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-1135
Practice Address - Country:US
Practice Address - Phone:386-673-3345
Practice Address - Fax:386-672-1854
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS3838207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL038175600Medicaid
FLK1031Medicare ID - Type Unspecified
FL60614Medicare UPIN
FL82260AMedicare ID - Type Unspecified