Provider Demographics
NPI:1003873837
Name:LEUZZI, JENNIFER L (OPTICIAN)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:LEUZZI
Suffix:
Gender:F
Credentials:OPTICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DANSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14437-1756
Mailing Address - Country:US
Mailing Address - Phone:585-335-9490
Mailing Address - Fax:
Practice Address - Street 1:14 MAIN ST
Practice Address - Street 2:
Practice Address - City:DANSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14437-1756
Practice Address - Country:US
Practice Address - Phone:585-335-9490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005220156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY103047CTOtherPREFERRED CARE
NYMOP14M144OtherBLUE CROSS-SHIELD
NYMOP14M144OtherBLUE CROSS-SHIELD