Healthcare Provider Details

I. General information

NPI: 1275655417
Provider Name (Legal Business Name): RICHARD A. JABLONSKI, DO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 HAND AVE SUITE A
ORMOND BEACH FL
32174-1135
US

IV. Provider business mailing address

1425 HAND AVE SUITE A
ORMOND BEACH FL
32174-1135
US

V. Phone/Fax

Practice location:
  • Phone: 386-673-3345
  • Fax: 386-672-1854
Mailing address:
  • Phone: 386-673-3345
  • Fax: 386-672-1854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberOS3838
License Number StateFL

VIII. Authorized Official

Name: DR. RICHARD A JABLONSKI
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 386-673-3345