Provider Demographics
NPI:1700085743
Name:BALSKI, GERARD JOSEPH JR (OD)
Entity Type:Individual
Prefix:DR
First Name:GERARD
Middle Name:JOSEPH
Last Name:BALSKI
Suffix:JR
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:12810 HUNTLEY MANOR DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-7906
Mailing Address - Country:US
Mailing Address - Phone:216-527-9244
Mailing Address - Fax:
Practice Address - Street 1:8808 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4621
Practice Address - Country:US
Practice Address - Phone:904-998-2255
Practice Address - Fax:904-998-2077
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 4294152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEA034ZMedicare PIN