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General NPI Number Information
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NPI Number | 1194743500
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Entity Type | Individual
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Provider Name | GAYLE P LEINWOHL OD
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Gender | Female
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 11/04/2015
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Provider Practice Location Address
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Address Line | 9397 SAN JOSE BLVD SUITE 2
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City | JACKSONVILLE
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State | FL
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Zip | 32257-5587
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Country | US
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Telephone | 904-730-2299
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Fax | 904-730-2557
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Provider Business Mailing Address
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Address Line | 9397 SAN JOSE BLVD SUITE 2
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City | JACKSONVILLE
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State | FL
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Zip | 32257-5587
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Country | US
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Telephone | 904-730-2299
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Fax | 904-730-2557
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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 | OPC 2993
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License Number State | FL
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