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General NPI Number Information
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NPI Number | 1679790141
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Entity Type | Organization
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Legal Business Name | JABALEY VISION ASSOCIATES
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 03/28/2008
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Provider Practice Location Address
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Address Line | 1333 DAMASCUS CIRCLE
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City | BLUE RIDGE
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State | GA
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Zip | 30513
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Country | US
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Telephone | 706-946-2020
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Fax | 706-946-2021
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Provider Business Mailing Address
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Address Line | 1333 DAMASCUS CIRCLE
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City | BLUE RIDGE
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State | GA
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Zip | 30513
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Country | US
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Telephone | 706-946-2020
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Fax | 706-946-2021
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SAMUEL CHRISTOPHER JABALEY
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Credential | O.D.
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Telephone | 706-946-2020
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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 | 1752
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License Number State | GA
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