Organization
LAKE RIDGE VISION CENTER PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD ANTHONY JABLONSKI O.D. (OPTOMETRIST)
(703) 680-4323
Entity
Organization
Contact information
Practice address
12444 DILLINGHAM SQ, WOODBRIDGE, VA 22192-5258
(703) 680-4323
(703) 680-4358
Mailing address
12444 DILLINGHAM SQ, WOODBRIDGE, VA 22192-5258
(703) 680-4323
(703) 680-4358
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1729424
AETNA HMO
VA
01
—
343378
ANTHEM BLUE CROSS BLUE SH
VA
01
—
5383-0000
CARE FIRST BCBS
VA
01
—
5946431
AETNA PPO
VA
01
—
CO2323
PTAN
VA
Enumeration date
04/09/2008
Last updated
09/22/2025
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