Provider Demographics
NPI:1639358344
Name:LEBLANC, CORNEL HUBERT (OD, FOAA)
Entity type:Individual
Prefix:DR
First Name:CORNEL
Middle Name:HUBERT
Last Name:LEBLANC
Suffix:
Gender:M
Credentials:OD, FOAA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5917 JACKSON STREET EXT
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-2048
Mailing Address - Country:US
Mailing Address - Phone:318-445-5292
Mailing Address - Fax:318-448-9627
Practice Address - Street 1:5917 JACKSON STREET EXT
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-2048
Practice Address - Country:US
Practice Address - Phone:318-445-5292
Practice Address - Fax:318-448-9627
Is Sole Proprietor?:No
Enumeration Date:2007-10-30
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA798123T152W00000X, 152WC0802X, 152WL0500X, 152WP0200X, 152WS0006X, 152WV0400X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WS0006XEye and Vision Services ProvidersOptometristSports Vision
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1174017Medicaid
LA1174017Medicaid
LA48228D966Medicare PIN