Provider Demographics
NPI:1962636407
Name:BLANCHARD, ANITA LORRAINE (OD)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:LORRAINE
Last Name:BLANCHARD
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 1:803 RIVERSIDE DRIVE
Mailing Address - Street 2:
Mailing Address - City:FRANKLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70438
Mailing Address - Country:US
Mailing Address - Phone:985-839-5633
Mailing Address - Fax:985-467-4218
Practice Address - Street 1:803 RIVERSIDE DRIVE
Practice Address - Street 2:
Practice Address - City:FRANKLINTON
Practice Address - State:LA
Practice Address - Zip Code:70438
Practice Address - Country:US
Practice Address - Phone:985-839-5633
Practice Address - Fax:985-467-4218
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-13
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1580-613T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2125061OtherMEDICARE
LA4R167Medicaid