Provider Demographics
NPI:1932434909
Name:LEBLANC, MEREDITH BRYNE (OD)
Entity Type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:BRYNE
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MEREDITH
Other - Middle Name:BRYNE
Other - Last Name:GODINO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:640 SUMMIT CROSSING PL
Mailing Address - Street 2:SUITE 202
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28054-2138
Mailing Address - Country:US
Mailing Address - Phone:704-865-3937
Mailing Address - Fax:
Practice Address - Street 1:640 SUMMIT CROSSING PL
Practice Address - Street 2:SUITE 202
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28054-2138
Practice Address - Country:US
Practice Address - Phone:704-865-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2012-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2152152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5915268Medicaid
NC157P0OtherBLUE CROSS BLUE SHIELD
NC2403312PMedicare PIN
NCNC3249DMedicare PIN
NC2403312JMedicare PIN
NC2403312KMedicare PIN
NC2403312OMedicare PIN
NCNC3249CMedicare PIN
NC2403312AMedicare PIN
NC2403312EMedicare PIN
NC5915268Medicaid
NC2403312MMedicare PIN
NC2403312NMedicare PIN
NCNC3249BMedicare PIN
NC2403312Medicare PIN