Healthcare Provider Details

I. General information

NPI: 1942438015
Provider Name (Legal Business Name): BENJAMIN HUGHSTON LEISHMAN OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2009
Last Update Date: 03/01/2024
Certification Date: 03/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9565 S 700 E STE 101
SANDY UT
84070-3482
US

IV. Provider business mailing address

9565 S 700 E STE 101
SANDY UT
84070-3482
US

V. Phone/Fax

Practice location:
  • Phone: 801-572-3937
  • Fax:
Mailing address:
  • Phone: 385-202-3937
  • Fax: 385-212-2484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number76555999934
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number76555999934
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number76555999934
License Number StateUT
# 4
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number76555999934
License Number StateUT
# 5
Primary TaxonomyN
Taxonomy Code152WS0006X
TaxonomySports Vision Optometrist
License Number76555999934
License Number StateUT
# 6
Primary TaxonomyN
Taxonomy Code152WV0400X
TaxonomyVision Therapy Optometrist
License Number76555999934
License Number StateUT
# 7
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number76555999934
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: