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General NPI Number Information
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NPI Number | 1407996176
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Entity Type | Individual
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Provider Name | ILYA M LEYNGOLD MD
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Gender | Male
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 11/10/2022
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Provider Practice Location Address
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Address Line | 3015 E GOLDSTONE DR # 130
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City | MERIDIAN
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State | ID
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Zip | 83642-1549
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Country | US
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Telephone | 208-900-4673
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Fax | 208-266-5033
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Provider Business Mailing Address
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Address Line | 3015 E GOLDSTONE DR # 130
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City | MERIDIAN
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State | ID
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Zip | 83642-1549
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Country | US
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Telephone | 208-900-4673
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Fax | 208-266-5033
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME112787
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207WX0200X
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Taxonomy Name | Ophthalmic Plastic and Reconstructive Surgery Physician
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License Number | ME112787
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 207WX0200X
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Taxonomy Name | Ophthalmic Plastic and Reconstructive Surgery Physician
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License Number | 2016-00134
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License Number State | NC
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