Individual
DR. MARK G BLASBALG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1193 TIOGUE AVE, COVENTRY, RI 02816-6122
(401) 823-8200
(401) 826-8708
Mailing address
1193 TIOGUE AVE, COVENTRY, RI 02816-6122
(401) 823-8200
(401) 826-8708
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
2777
MA
152W00000X
Optometrist
Primary
ODTG00489
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9009739
—
RI
Enumeration date
08/31/2006
Last updated
07/09/2007
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