Healthcare Provider Details

I. General information

NPI: 1730172842
Provider Name (Legal Business Name): WILLIAM JAMES LEAHEY JR. OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 12/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 MOHAWK ST
COHOES NY
12047-2809
US

IV. Provider business mailing address

12 GREEN HILL RD
RENSSELAER NY
12144-5801
US

V. Phone/Fax

Practice location:
  • Phone: 518-237-0342
  • Fax: 518-235-9266
Mailing address:
  • Phone: 518-283-5054
  • Fax: 518-283-5054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberTUV003765-0
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: