Healthcare Provider Details

I. General information

NPI: 1942933247
Provider Name (Legal Business Name): EMILY LEACH OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: EMILY JANSE VAN RENSBURG OD

II. Dates (important events)

Enumeration Date: 07/05/2022
Last Update Date: 06/11/2024
Certification Date: 06/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 COMMONWEALTH AVE
BOSTON MA
02215-1274
US

IV. Provider business mailing address

37 ELM ST
MELROSE MA
02176-2323
US

V. Phone/Fax

Practice location:
  • Phone: 617-262-2020
  • Fax:
Mailing address:
  • Phone: 857-206-2929
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number5548
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: