MEDICARE: DR. STANLEY JOHN BLYSKAL O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	2807	NJ

General Provider Information

NPI Number	:	1255319190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STANLEY JOHN BLYSKAL O.D.

Provider Business Mailing Address
First Line	:	123 W WASHINGTON AVE
Second Line	:
City	:	WASHINGTON
State	:	NJ
Zip	:	07882-2121
Country	:	US
Telephone Number	:	908-689-1214
Fax Number	:	908-689-2960

Provider Business Practice Location Address
First Line	:	123 W WASHINGTON AVE
Second Line	:
City	:	WASHINGTON
State	:	NJ
Zip	:	07882-2121
Country	:	US
Telephone Number	:	908-689-1214
Fax Number	:	908-689-2960

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/31/2005
Last Update Date	:	07/08/2007

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