Healthcare Provider Details

I. General information

NPI: 1548234123
Provider Name (Legal Business Name): H CHAPMAN LEFFINGWELL O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2006
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14151 W NATIONAL AVE
NEW BERLIN WI
53151-4528
US

IV. Provider business mailing address

1950 OLD GALLOWS RD STE 520
VIENNA VA
22182-3970
US

V. Phone/Fax

Practice location:
  • Phone: 414-541-2100
  • Fax: 414-541-2377
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WX0102X
TaxonomyOccupational Vision Optometrist
License Number2312
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number2312-35
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: