Organization
MARK G. BLASBALG OD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK G BLASBALG O.D. (OWNER PRESIDENT)
(401) 823-8200
Entity
Organization
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
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9009739
—
RI
Enumeration date
01/03/2007
Last updated
03/09/2010
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