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

Table of content: DR. J. JEFFREY LEINWAND O.D. (NPI 1942204748)

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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