Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 0618000066 | VA |
NPI | 1295796712 |
---|---|
Provider Name | Dr. Richard A. Jablonski |
First Address | Woodbridge, VA 22192-5258 |
Second Address | Woodbridge, VA 22192-5258 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/04/2006 |
Last Update Date | 05/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
031112 | BLUE CROSS BLUE SHIELD (01) | VA |
2129817 | AETNA HMO (01) | VA |
311873 | UNITED HEALTHYCARE/OPT CH (01) | VA |
4461542 | AETNA PPO (01) | VA |
54-1330725 | TRICARE (01) | VA |
U410091 | (02) | VA |