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General NPI Number Information
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NPI Number | 1073784351
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Entity Type | Organization
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Legal Business Name | DONALD B. LEACH, O.D., P.C.
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Dates
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Enumeration Date | 03/14/2008
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Last Update Date | 10/09/2012
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Provider Practice Location Address
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Address Line | 943 MAIN STREET SW
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City | LOS LUNAS
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State | NM
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Zip | 87031-8748
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Country | US
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Telephone | 505-865-4812
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Fax | 505-865-3767
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Provider Business Mailing Address
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Address Line | 943 MAIN STREET SW
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City | LOS LUNAS
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State | NM
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Zip | 87031-8748
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Country | US
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Telephone | 505-865-4812
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Fax | 505-865-3767
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Authorized Official
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Title or Position | PRESIDENT/DOCTOR
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Name | DR. DONALD B LEACH
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Credential | O.D.
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Telephone | 505-865-4812
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | 245/OP2245
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 245/OP2245
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License Number State | NM
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