MEDICARE: MINDY STERNER LEACH OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	540	MT
2	152WX0102X	Occupational Vision Optometrist	540	MT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497756340
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINDY STERNER LEACH OD

Provider Business Mailing Address
First Line	:	2012 14TH ST SW
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59404-3486
Country	:	US
Telephone Number	:	406-452-4527
Fax Number	:	406-453-1900

Provider Business Practice Location Address
First Line	:	2012 14TH ST SW
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59404-3486
Country	:	US
Telephone Number	:	406-452-4527
Fax Number	:	406-453-1900

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	10/24/2014

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