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General NPI Number Information
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NPI Number | 1285807404
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Entity Type | Organization
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Legal Business Name | LAKE RIDGE VISION CENTER PLLC
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Dates
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Enumeration Date | 04/09/2008
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Last Update Date | 09/22/2025
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Provider Practice Location Address
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Address Line | 12444 DILLINGHAM SQ
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City | WOODBRIDGE
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State | VA
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Zip | 22192-5258
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Country | US
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Telephone | 703-680-4323
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Fax | 703-680-4358
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Provider Business Mailing Address
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Address Line | 12444 DILLINGHAM SQ
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City | WOODBRIDGE
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State | VA
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Zip | 22192-5258
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Country | US
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Telephone | 703-680-4323
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Fax | 703-680-4358
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. RICHARD ANTHONY JABLONSKI
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Credential | O.D.
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Telephone | 703-680-4323
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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