1942204748 NPI number — DR. J. JEFFREY LEINWAND O.D.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942204748 NPI number — DR. J. JEFFREY LEINWAND O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LEINWAND
Provider First Name:
J.
Provider Middle Name:
JEFFREY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LEINWAND
Provider Other First Name:
JOSPEPH
Provider Other Middle Name:
JEFFREY
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1942204748
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/19/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 WARSAW RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLINTON
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28328-3520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
910-592-3152
Provider Business Mailing Address Fax Number:
910-592-3153

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 WARSAW RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28328-3520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-592-3152
Provider Business Practice Location Address Fax Number:
910-592-3153
Provider Enumeration Date:
06/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  0953 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 561215293 . This is a "CIGNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: NC0953 . This is a "SUPERIOR VISION" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 561215293 . This is a "NC HEALTH CHOICE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 561215293 . This is a "AETNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: NC0953 . This is a "EYEMED" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 890912L , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0912L . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 10530 . This is a "SPECTERA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 17155 . This is a "AVESIS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0905700002 . This is a "PALMETTO SUPPLIER NUMBER" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 2256219 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 561215293 . This is a "VISION SERVICE PLAN" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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