Healthcare Provider Details

I. General information

NPI: 1093632903
Provider Name (Legal Business Name): ERIN LEYDEN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

640 E MICHIGAN ST STE B
INDIANAPOLIS IN
46202-0035
US

IV. Provider business mailing address

350 MONON BLVD APT 505
CARMEL IN
46032-2385
US

V. Phone/Fax

Practice location:
  • Phone: 317-929-1401
  • Fax:
Mailing address:
  • Phone: 847-508-5835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number18004689A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: