Provider Demographics
NPI:1689785651
Name:BARNES-LEBLANC, CHAROLETTE A (OD)
Entity Type:Individual
Prefix:
First Name:CHAROLETTE
Middle Name:A
Last Name:BARNES-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 1:29314 BIRDY CT
Mailing Address - Street 2:
Mailing Address - City:NUEVO
Mailing Address - State:CA
Mailing Address - Zip Code:92567-9493
Mailing Address - Country:US
Mailing Address - Phone:951-940-8100
Mailing Address - Fax:
Practice Address - Street 1:1688 N PERRIS BLVD
Practice Address - Street 2:STE L5
Practice Address - City:PERRIS
Practice Address - State:CA
Practice Address - Zip Code:92571-4709
Practice Address - Country:US
Practice Address - Phone:951-940-8100
Practice Address - Fax:951-940-0780
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2017-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8665T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0086651Medicaid
CASD0086650Medicare PIN
CA5143620001Medicare NSC
CA83919Medicare UPIN