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NPI Code Detail

MEDICARE: DR. WILLIAM JAMES LEAHEY JR. OD

MEDICARE: DR. WILLIAM JAMES LEAHEY JR. 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
1152W00000XOptometristTUV003765-0NY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1442580078OTHERNYRAILROAD MEDICARE

General Provider Information

NPI Number : 1730172842
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WILLIAM JAMES LEAHEY JR. OD
Provider Business Mailing Address
First Line : 12 GREEN HILL RD
Second Line :
City : RENSSELAER
State : NY
Zip : 12144-5801
Country : US
Telephone Number : 518-283-5054
Fax Number : 518-283-5054
Provider Business Practice Location Address
First Line : 91 MOHAWK ST
Second Line :
City : COHOES
State : NY
Zip : 12047-2809
Country : US
Telephone Number : 518-237-0342
Fax Number : 518-235-9266
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2005
Last Update Date : 12/22/2014

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