Provider Demographics
NPI:1942204748
Name:LEINWAND, J. JEFFREY (OD)
Entity Type:Individual
Prefix:DR
First Name:J.
Middle Name:JEFFREY
Last Name:LEINWAND
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:JOSPEPH
Other - Middle Name:JEFFREY
Other - Last Name:LEINWAND
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:100 WARSAW RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-3520
Mailing Address - Country:US
Mailing Address - Phone:910-592-3152
Mailing Address - Fax:910-592-3153
Practice Address - Street 1:100 WARSAW RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-3520
Practice Address - Country:US
Practice Address - Phone:910-592-3152
Practice Address - Fax:910-592-3153
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-09
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0953152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC561215293OtherCIGNA
NCNC0953OtherSUPERIOR VISION
NC561215293OtherNC HEALTH CHOICE
NC561215293OtherAETNA
NCNC0953OtherEYEMED
NC890912LMedicaid
NC0912LOtherBLUE CROSS BLUE SHIELD
NC10530OtherSPECTERA
NC17155OtherAVESIS
NC0905700002OtherPALMETTO SUPPLIER NUMBER
NC2256219OtherUNITED HEALTHCARE
NC561215293OtherVISION SERVICE PLAN
NC246253Medicare ID - Type Unspecified
NC561215293OtherNC HEALTH CHOICE