Provider Demographics
NPI:1700234754
Name:BLATT, JENNA BLECHMAN (OD)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:BLECHMAN
Last Name:BLATT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:RENEE
Other - Last Name:BLECHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1116 NE 117TH ST
Mailing Address - Street 2:
Mailing Address - City:BISCAYNE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33161-6752
Mailing Address - Country:US
Mailing Address - Phone:561-702-1899
Mailing Address - Fax:
Practice Address - Street 1:3015 GRAND AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33133-5144
Practice Address - Country:US
Practice Address - Phone:786-216-7850
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-01
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC5226152W00000X
NYTUV008666152W00000X, 152W00000X
TX10189TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist