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General NPI Number Information
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NPI Number | 1649387549
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Entity Type | Individual
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Provider Name | BRIAN A LEAK O.D.
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Gender | Male
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Dates
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Enumeration Date | 08/24/2006
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Last Update Date | 11/17/2009
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Provider Practice Location Address
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Address Line | 6111 NE CORNELL RD EYE HEALTH NORTHWEST
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City | HILLSBORO
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State | OR
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Zip | 97124-5410
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Country | US
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Telephone | 503-846-9400
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Fax | 503-846-9500
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Provider Business Mailing Address
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Address Line | 11086 SE OAK STREET EYE HEALTH NORTHWEST
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City | MILWAUKIE
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State | OR
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Zip | 97222
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Country | US
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Telephone | 503-344-5102
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Fax | 503-344-5110
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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 | 3300ATI
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License Number State | OR
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