Provider Demographics
NPI:1831283472
Name:BLANCQ, CINDY W (OD)
Entity Type:Individual
Prefix:DR
First Name:CINDY
Middle Name:W
Last Name:BLANCQ
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 1:16871 PRIMROSE LANE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649
Mailing Address - Country:US
Mailing Address - Phone:949-275-2022
Mailing Address - Fax:
Practice Address - Street 1:400 NEWPORT CENTER DRIVE
Practice Address - Street 2:SUITE #404
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-640-2023
Practice Address - Fax:949-640-7182
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2012-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11526152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU96145Medicare UPIN