Healthcare Provider Details

I. General information

NPI: 1821285016
Provider Name (Legal Business Name): LEANNA MARIE DUDLEY O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2007
Last Update Date: 06/10/2024
Certification Date: 06/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1450 HOYT ST
LAKEWOOD CO
80215-4763
US

IV. Provider business mailing address

1450 HOYT ST
LAKEWOOD CO
80215-4763
US

V. Phone/Fax

Practice location:
  • Phone: 303-433-3277
  • Fax: 303-433-3278
Mailing address:
  • Phone: 303-433-3277
  • Fax: 303-433-3278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number56007344
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2707
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: