Provider Demographics
NPI:1871715276
Name:JABLONOWSKI, LYNN DARIA (OD)
Entity type:Individual
Prefix:DR
First Name:LYNN
Middle Name:DARIA
Last Name:JABLONOWSKI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 KITTANNING PIKE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15215-1117
Mailing Address - Country:US
Mailing Address - Phone:412-781-8859
Mailing Address - Fax:
Practice Address - Street 1:105 FREEPORT RD
Practice Address - Street 2:SUITE 2
Practice Address - City:ASPINWALL
Practice Address - State:PA
Practice Address - Zip Code:15215-2943
Practice Address - Country:US
Practice Address - Phone:412-781-1120
Practice Address - Fax:412-781-1130
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001873152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1724972Medicaid
PA1724972Medicaid
PA810982OtherEYEMED
PA1724972Medicaid