Provider Demographics
NPI:1639140130
Name:GEERTS, LEANN LYNETTE (OD)
Entity Type:Individual
Prefix:DR
First Name:LEANN
Middle Name:LYNETTE
Last Name:GEERTS
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 1:1729 NEW HANOVER MEDICAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-5345
Mailing Address - Country:US
Mailing Address - Phone:910-763-3601
Mailing Address - Fax:
Practice Address - Street 1:1729 NEW HANOVER MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-5345
Practice Address - Country:US
Practice Address - Phone:910-763-3601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-01
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1133152W00000X
NC1754152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC093V7OtherBCBS OF NC
NC5908111Medicaid
NC2403702Medicare PIN
NC5908111Medicaid