MEDICARE: DR. BENJAMIN HUGHSTON LEISHMAN 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	152WV0400X	Vision Therapy Optometrist	76555999934	UT
2	152WX0102X	Occupational Vision Optometrist	76555999934	UT
3	152W00000X	Optometrist	76555999934	UT
4	152WL0500X	Low Vision Rehabilitation Optometrist	76555999934	UT
5	152WP0200X	Pediatric Optometrist	76555999934	UT
6	152WS0006X	Sports Vision Optometrist	76555999934	UT
7	152WC0802X	Corneal and Contact Management Optometrist	76555999934	UT

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1942438015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN HUGHSTON LEISHMAN OD

Provider Business Mailing Address
First Line	:	9565 S 700 E STE 101
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84070-3482
Country	:	US
Telephone Number	:	385-202-3937
Fax Number	:	385-212-2484

Provider Business Practice Location Address
First Line	:	9565 S 700 E STE 101
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84070-3482
Country	:	US
Telephone Number	:	801-572-3937
Fax Number	:

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

Provider Enumeration Date	:	06/29/2009
Last Update Date	:	03/01/2024

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Directions to “ DR. BENJAMIN HUGHSTON LEISHMAN OD” Practice Location

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