MEDICARE: LINDA FAYE LELAND OD

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	4901002885	MI

General Provider Information

NPI Number	:	1225125214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDA FAYE LELAND OD

Provider Business Mailing Address
First Line	:	403 SHORE CLUB DR
Second Line	:
City	:	SAINT CLAIR SHORES
State	:	MI
Zip	:	48080-1557
Country	:	US
Telephone Number	:	586-777-3712
Fax Number	:

Provider Business Practice Location Address
First Line	:	5321 S TELEGRAPH RD
Second Line	:
City	:	DEARBORN HEIGHTS
State	:	MI
Zip	:	48125-2031
Country	:	US
Telephone Number	:	313-292-7770
Fax Number	:

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

Provider Enumeration Date	:	10/09/2006
Last Update Date	:	07/08/2007

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