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General NPI Number Information
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NPI Number | 1558589796
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Entity Type | Organization
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Legal Business Name | DEANNE LEONARD OD LLC
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Dates
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Enumeration Date | 04/23/2007
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Last Update Date | 08/10/2009
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Provider Practice Location Address
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Address Line | 3506 ELLAMONT RD
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City | BALTIMORE
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State | MD
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Zip | 21215
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Country | US
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Telephone | 443-802-9920
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Fax | 443-926-9920
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Provider Business Mailing Address
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Address Line | 3506 ELLAMONT RD
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City | BALTIMORE
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State | MD
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Zip | 21215
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Country | US
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Telephone | 443-802-9920
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Fax | 443-926-9920
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DEANNE LEONARD
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Credential |
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Telephone | 443-802-9920
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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 | TA-1862
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License Number State | MD
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