Provider Demographics
NPI:1366623787
Name:LEBLANC, ALLISON RENEE (OD)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:RENEE
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:613 HAWTHORNE AVE S
Mailing Address - Street 2:
Mailing Address - City:LEHIGH ACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33974-9712
Mailing Address - Country:US
Mailing Address - Phone:239-303-7362
Mailing Address - Fax:
Practice Address - Street 1:2913 LEE BLVD
Practice Address - Street 2:
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1438
Practice Address - Country:US
Practice Address - Phone:239-368-9900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC 3670152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist