Provider Demographics
NPI:1770582108
Name:BLAHA, ELINA (OD)
Entity type:Individual
Prefix:
First Name:ELINA
Middle Name:
Last Name:BLAHA
Suffix:
Gender:F
Credentials:OD
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 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
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2009-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0601800141152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA44758OtherOPTIMAHEALTH
VA384117OtherANTHEM BC/BS
VA9232869Medicaid
VA44758OtherOPTIMAHEALTH