Individual
JAMIE L BLAVAT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
1513 PARK AVE FL 1, COLUMBUS, WI 53925-1793
(920) 623-2431
(920) 623-3656
Mailing address
1808 W BELTLINE HWY, MADISON, WI 53713-2334
(608) 250-1497
(608) 250-1384
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3475-35
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1073034609
—
WI
Enumeration date
07/05/2017
Last updated
11/28/2022
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