MEDICARE: JASON LEONHARDT

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	0003142	CO

General Provider Information

NPI Number	:	1235512435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON LEONHARDT

Provider Business Mailing Address
First Line	:	7238 N ACADEMY BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3187
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7238 N ACADEMY BLVD
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-3187
Country	:	US
Telephone Number	:	719-592-9991
Fax Number	:

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

Provider Enumeration Date	:	07/07/2015
Last Update Date	:	07/07/2015

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Directions to “ JASON LEONHARDT ” Practice Location

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