MEDICARE: DR. RICHARD A JABLONSKI DO

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	207W00000X	Ophthalmology Physician	0S3838	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760474399
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD A JABLONSKI DO

Provider Business Mailing Address
First Line	:	1425 HAND AVE
Second Line	:	STE A
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-1135
Country	:	US
Telephone Number	:	386-673-3344
Fax Number	:	386-672-1854

Provider Business Practice Location Address
First Line	:	1425 HAND AVE
Second Line	:	STE A
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-1135
Country	:	US
Telephone Number	:	386-673-3344
Fax Number	:	386-672-1854

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

Provider Enumeration Date	:	08/19/2005
Last Update Date	:	10/26/2011

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