MEDICARE: KENT G LEAVITT MD

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	207WX0120X	Cornea and External Diseases Specialist Physician	MD00028489	WA
2	207W00000X	Ophthalmology Physician	MD00028489	WA

General Provider Information

NPI Number	:	1528062320
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KENT G LEAVITT MD

Provider Business Mailing Address
First Line	:	2285 116TH AVE NE
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98004-3015
Country	:	US
Telephone Number	:	425-426-2880
Fax Number	:	425-450-9696

Provider Business Practice Location Address
First Line	:	1135 116TH AVE NE STE 450
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98004-4623
Country	:	US
Telephone Number	:	425-450-6990
Fax Number	:	425-450-8807

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

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	10/08/2019

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