Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | TA1862 | MD |
NPI | 1003902016 |
---|---|
Provider Name | Deanne Leonard |
First Address | Baltimore, MD 21215 |
Second Address | Baltimore, MD 21215 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/10/2006 |
Last Update Date | 18/01/2013 |