Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 3355 | MA |
NPI | 1003882879 |
---|---|
Provider Name | Dr. Alan Leavitt |
First Address | Mashpee, MA 02649 |
Second Address | Mashpee, MA 02649 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/02/2006 |
Last Update Date | 14/08/2008 |