MEDICARE: DR. LEO A GAW O.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	007414	NY

General Provider Information

NPI Number	:	1154550929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEO A GAW O.D

Provider Business Mailing Address
First Line	:	108 N LORRAINE AVE # 2
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13210-3222
Country	:	US
Telephone Number	:	626-202-8431
Fax Number	:

Provider Business Practice Location Address
First Line	:	125 LAWRENCE RD E
Second Line	:
City	:	NORTH SYRACUSE
State	:	NY
Zip	:	13212-3844
Country	:	US
Telephone Number	:	315-455-5500
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2009
Last Update Date	:	07/14/2009

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