Provider Demographics
NPI:1760474399
Name:JABLONSKI, RICHARD A (DO)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:A
Last Name:JABLONSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1425 HAND AVE
Mailing Address - Street 2:STE A
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-1135
Mailing Address - Country:US
Mailing Address - Phone:386-673-3344
Mailing Address - Fax:386-672-1854
Practice Address - Street 1:1425 HAND AVE
Practice Address - Street 2:STE A
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-1135
Practice Address - Country:US
Practice Address - Phone:386-673-3344
Practice Address - Fax:386-672-1854
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL0S3838207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL038175600Medicaid
60614Medicare UPIN
FL038175600Medicaid
82260AMedicare ID - Type Unspecified