Provider Demographics
NPI:1093931271
Name:CHERVENKA, LEIGH SHA R (OD)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:SHA R
Last Name:CHERVENKA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 NORTH PEPPERELL ROAD
Mailing Address - Street 2:
Mailing Address - City:HOLLIS
Mailing Address - State:NH
Mailing Address - Zip Code:82009
Mailing Address - Country:US
Mailing Address - Phone:603-465-3530
Mailing Address - Fax:
Practice Address - Street 1:163 AMHERST ST STE C
Practice Address - Street 2:
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03064-1367
Practice Address - Country:US
Practice Address - Phone:603-320-8880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH817152W00000X
WY304T152W00000X
MA4229TP152W00000X
TX5106T152W00000X
SD561152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist