Provider Demographics
NPI:1679790141
Name:JABALEY VISION ASSOCIATES
Entity type:Organization
Organization Name:JABALEY VISION ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:JABALEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:706-946-2020
Mailing Address - Street 1:1333 DAMASCUS CIRCLE
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30513
Mailing Address - Country:US
Mailing Address - Phone:706-946-2020
Mailing Address - Fax:706-946-2021
Practice Address - Street 1:1333 DAMASCUS CIRCLE
Practice Address - Street 2:
Practice Address - City:BLUE RIDGE
Practice Address - State:GA
Practice Address - Zip Code:30513
Practice Address - Country:US
Practice Address - Phone:706-946-2020
Practice Address - Fax:706-946-2021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-19
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1752152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA4485240001OtherDMERC MEDICARE
GAU77626Medicare UPIN