MEDICARE: DR. JANE H LEIDLEIN M.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	207WX0107X	Retina Specialist (Ophthalmology) Physician	J4298	TX
2	207W00000X	Ophthalmology Physician	J4298	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	180036211	OTHER	TX	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10017638	OTHER	TX	AMERIGROUP
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	8S4250	OTHER	TX	BCBS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235110719
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANE H LEIDLEIN M.D.

Provider Business Mailing Address
First Line	:	117 CIRCLE WAY ST
Second Line	:
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-5233
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	117 CIRCLE WAY ST
Second Line	:
City	:	LAKE JACKSON
State	:	TX
Zip	:	77566-5233
Country	:	US
Telephone Number	:	979-297-4042
Fax Number	:

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

Provider Enumeration Date	:	11/10/2005
Last Update Date	:	06/02/2022

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Directions to “ DR. JANE H LEIDLEIN M.D.” Practice Location

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