Provider Demographics
NPI:1356581631
Name:JADOFSKY, HOWARD DANA
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:DANA
Last Name:JADOFSKY
Suffix:
Gender:M
Credentials:
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 1315
Mailing Address - Street 2:
Mailing Address - City:STANARDSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:22973-1315
Mailing Address - Country:US
Mailing Address - Phone:434-531-5071
Mailing Address - Fax:434-990-0126
Practice Address - Street 1:102 MAIN ST
Practice Address - Street 2:
Practice Address - City:STANARDSVILLE
Practice Address - State:VA
Practice Address - Zip Code:22973-2970
Practice Address - Country:US
Practice Address - Phone:434-531-5071
Practice Address - Fax:434-990-0126
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1101001285156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician