MEDICARE: KAREN LEE LEYDE

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

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
2	6C243EY	OTHER	MN	BLUE SHIELD OF MN

General Provider Information

NPI Number	:	1841327111
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KAREN LEE LEYDE

Provider Business Mailing Address
First Line	:	6575 CAHILL AVE STE 101
Second Line	:
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55076-2065
Country	:	US
Telephone Number	:	651-451-1100
Fax Number	:	651-451-3939

Provider Business Practice Location Address
First Line	:	6575 CAHILL AVE STE 101
Second Line	:
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55076-2065
Country	:	US
Telephone Number	:	651-451-1100
Fax Number	:	651-451-3939

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. KAREN LEE LEYDE
Credential	:
Telephone Number	:	651-451-1100

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	03/02/2010

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