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General NPI Number Information
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NPI Number | 1003882879
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Entity Type | Individual
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Provider Name | ALAN LEAVITT O.D.
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Gender | Male
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Dates
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Enumeration Date | 02/23/2006
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Last Update Date | 08/14/2008
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Provider Practice Location Address
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Address Line | 9 MARKET ST. MASHPEE COMMONS
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City | MASHPEE
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State | MA
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Zip | 02649
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Country | US
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Telephone | 508-477-7423
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Fax | 508-477-0584
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Provider Business Mailing Address
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Address Line | 9 MARKET ST. MASHPEE COMMONS PO BOX 1410
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City | MASHPEE
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State | MA
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Zip | 02649
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Country | US
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Telephone | 508-477-7423
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Fax | 508-477-0584
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3355
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License Number State | MA
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