Provider Demographics
NPI:1093942641
Name:LEONARD OPTICIAN INC.,
Entity Type:Organization
Organization Name:LEONARD OPTICIAN INC.,
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:DUPELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-249-9033
Mailing Address - Street 1:119 NEW ATHOL RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:MA
Mailing Address - Zip Code:01364-9603
Mailing Address - Country:US
Mailing Address - Phone:978-249-9033
Mailing Address - Fax:978-249-9020
Practice Address - Street 1:119 NEW ATHOL RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:MA
Practice Address - Zip Code:01364-9603
Practice Address - Country:US
Practice Address - Phone:978-249-9033
Practice Address - Fax:978-249-9020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-22
Last Update Date:2009-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA79237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9737651Medicaid