Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 5780TG | TX |
NPI | 1003888470 |
---|---|
Provider Name | Joshua E Leif |
First Address | Pearland, TX 77584-7298 |
Second Address | Houston, TX 77025-1669 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/02/2006 |
Last Update Date | 10/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
205988304 | (05) | TX |
205988305 | (05) | TX |
205988306 | (05) | TX |
U79577 | (02) | TX |