Healthcare Provider Details

I. General information

NPI: 1225231673
Provider Name (Legal Business Name): BYRON WILLIAM LEEDS O.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11250 E COLONIAL DR
ORLANDO FL
32817-4537
US

IV. Provider business mailing address

2854 PALMETTO RIDGE PT
OVIEDO FL
32765-7370
US

V. Phone/Fax

Practice location:
  • Phone: 407-249-8666
  • Fax:
Mailing address:
  • Phone: 407-977-2821
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number3303
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: