MEDICARE: VALERIE A LEFF OD

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	1503	NE

General Provider Information

NPI Number	:	1821659319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE A LEFF OD

Provider Business Mailing Address
First Line	:	211 E BROADWAY
Second Line	:
City	:	ALTON
State	:	IL
Zip	:	62002-6220
Country	:	US
Telephone Number	:	618-462-9818
Fax Number	:	314-741-4947

Provider Business Practice Location Address
First Line	:	2545 S 132ND ST
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68144-2532
Country	:	US
Telephone Number	:	402-330-4330
Fax Number	:

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

Provider Enumeration Date	:	06/25/2019
Last Update Date	:	06/25/2019

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