MEDICARE: DR BYRON W LEEDS OD PA

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	152WC0802X	Corneal and Contact Management Optometrist	3303	FL

General Provider Information

NPI Number	:	1790066553
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR BYRON W LEEDS OD PA

Provider Business Mailing Address
First Line	:	2854 PALMETTO RIDGE PT
Second Line	:
City	:	OVIEDO
State	:	FL
Zip	:	32765-7370
Country	:	US
Telephone Number	:	407-977-2821
Fax Number	:

Provider Business Practice Location Address
First Line	:	11250 E COLONIAL DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32817-4537
Country	:	US
Telephone Number	:	407-249-8666
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BYRON WILLIAM LEEDS
Credential	:	O.D.
Telephone Number	:	407-249-8666

Provider Enumeration Date	:	09/07/2011
Last Update Date	:	02/01/2012

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