Provider Demographics
NPI:1235483934
Name:BLANC, GEORGINA MARIE (OD)
Entity Type:Individual
Prefix:
First Name:GEORGINA
Middle Name:MARIE
Last Name:BLANC
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8230 MIRA MESA BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92126-2625
Mailing Address - Country:US
Mailing Address - Phone:858-566-6670
Mailing Address - Fax:
Practice Address - Street 1:613 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4402
Practice Address - Country:US
Practice Address - Phone:760-747-7979
Practice Address - Fax:760-747-7799
Is Sole Proprietor?:No
Enumeration Date:2012-11-01
Last Update Date:2018-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14552152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist