Provider Demographics
NPI:1235913005
Name:LINEBERRY, LOGAN (OD)
Entity type:Individual
Prefix:DR
First Name:LOGAN
Middle Name:
Last Name:LINEBERRY
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 1:10110 GREEN LEVEL CHURCH RD STE 102
Mailing Address - Street 2:
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27519-8155
Mailing Address - Country:US
Mailing Address - Phone:919-465-7400
Mailing Address - Fax:919-465-7455
Practice Address - Street 1:10110 GREEN LEVEL CHURCH RD STE 102
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-8155
Practice Address - Country:US
Practice Address - Phone:919-465-7400
Practice Address - Fax:919-465-7455
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-23
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4644ATI152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WV0400XEye and Vision Services ProvidersOptometristVision TherapyGroup - Single Specialty