Provider Demographics
NPI:1679752299
Name:PAUL-BLANC, DEANNA MICHELLE (OD)
Entity Type:Individual
Prefix:
First Name:DEANNA
Middle Name:MICHELLE
Last Name:PAUL-BLANC
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:DEANNA
Other - Middle Name:MICHELL
Other - Last Name:LOVRAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:9156 MENTOR AVE
Mailing Address - Street 2:
Mailing Address - City:MENTOR
Mailing Address - State:OH
Mailing Address - Zip Code:44060-6479
Mailing Address - Country:US
Mailing Address - Phone:440-578-5046
Mailing Address - Fax:440-578-5047
Practice Address - Street 1:9156 MENTOR AVE
Practice Address - Street 2:
Practice Address - City:MENTOR
Practice Address - State:OH
Practice Address - Zip Code:44060-6479
Practice Address - Country:US
Practice Address - Phone:440-578-5046
Practice Address - Fax:440-578-5047
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2012-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6091152W00000X
IL046010306152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist