Provider Demographics
NPI:1285816041
Name:DR. BLAHA AND ASSOCIATE OPTOMETRISTS
Entity Type:Organization
Organization Name:DR. BLAHA AND ASSOCIATE OPTOMETRISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELINA
Authorized Official - Middle Name:SHVETS
Authorized Official - Last Name:BLAHA
Authorized Official - Suffix:
Authorized Official - Credentials:OD,
Authorized Official - Phone:757-988-8903
Mailing Address - Street 1:PO BOX 14292
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23608-0006
Mailing Address - Country:US
Mailing Address - Phone:757-988-8903
Mailing Address - Fax:757-988-8903
Practice Address - Street 1:12407 JEFFERSON AVE
Practice Address - Street 2:SUITE A
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23602-4311
Practice Address - Country:US
Practice Address - Phone:757-988-8903
Practice Address - Fax:757-988-8903
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2009-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618000985152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAC10571Medicare PIN