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General NPI Number Information
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NPI Number | 1700445731
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Entity Type | Individual
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Provider Name | JOSHUA SHANE LEONARD OD
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Gender | Male
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Dates
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Enumeration Date | 06/12/2019
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Last Update Date | 12/28/2023
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Provider Practice Location Address
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Address Line | 4022 E BROADWAY RD STE 104
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City | PHOENIX
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State | AZ
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Zip | 85040-8824
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Country | US
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Telephone | 480-508-2155
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Fax | 877-283-0573
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Provider Business Mailing Address
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Address Line | 501 E LEAH LN
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City | GILBERT
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State | AZ
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Zip | 85234-2437
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Country | US
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Telephone | 480-508-2155
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Fax | 877-283-0573
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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 | OPT-002342
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License Number State | AZ
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