MEDICARE: LEENER CORP.

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	TUV003420-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1386664795
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEENER CORP.

Provider Business Mailing Address
First Line	:	7903 BREWERTON RD
Second Line	:	WEST MARINE PLAZA
City	:	CICERO
State	:	NY
Zip	:	13039-9531
Country	:	US
Telephone Number	:	315-699-1700
Fax Number	:	315-699-1707

Provider Business Practice Location Address
First Line	:	7903 BREWERTON RD
Second Line	:	WEST MARINE PLAZA
City	:	CICERO
State	:	NY
Zip	:	13039-9531
Country	:	US
Telephone Number	:	315-699-1700
Fax Number	:	315-699-1707

Authorized Official
Title or Position	:	OPTOMETRIST
Name	:	DR. CARL FRANCIS AZZOTO
Credential	:	OD
Telephone Number	:	315-455-7001

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	09/10/2010

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