NPIMap

Organization Active NPI

Mark G. Blasbalg OD Inc

  • Optometrist
  • Coventry, RI
National Provider Identifier
1902963457
Registry record updated Mar 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
Legal business name
MARK G. BLASBALG OD INC
Practice address
1193 Tiogue Ave
Coventry, RI 02816-6122
Phone
(401) 823-8200
Fax
(401) 826-8708
NPI assigned
Jan 3, 2007
Last updated
Mar 9, 2010By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 9, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mark G Blasbalg, O.D.NPI 1366554420
Title
Owner President
Phone
(401) 823-8200

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X Primary

Addresses

Primary practice location

1193 Tiogue Ave
Coventry, RI 02816-6122

Mailing address

1193 Tiogue Ave
Coventry, RI 02816-6122
Phone (401) 823-8200

Other identifiers 1

IdentifierTypeStateIssuer
9009739MedicaidRI

National Provider Directory

National Provider Directory

Locations

1193 Tiogue Ave
Coventry, RI 02816
Phone (401) 823-8200

Practitioners & affiliated clinicians

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1268092800000",
    "number": "1902963457",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1193 TIOGUE AVE",
            "city": "COVENTRY",
            "state": "RI",
            "postal_code": "028166122",
            "telephone_number": "401-823-8200",
            "fax_number": "401-826-8708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1193 TIOGUE AVE",
            "city": "COVENTRY",
            "state": "RI",
            "postal_code": "028166122",
            "telephone_number": "401-823-8200",
            "fax_number": "401-826-8708"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK G. BLASBALG OD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-01-03",
        "last_updated": "2010-03-09",
        "status": "A",
        "authorized_official_last_name": "BLASBALG",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER PRESIDENT",
        "authorized_official_telephone_number": "401-823-8200",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "9009739",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Coventry, RI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.