Provider Demographics
NPI:1104835693
Name:LEAZURE, MARY E (OD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:E
Last Name:LEAZURE
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:906 W MCDERMOTT DR STE 120
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-5424
Mailing Address - Country:US
Mailing Address - Phone:972-396-2021
Mailing Address - Fax:972-396-0242
Practice Address - Street 1:906 W MCDERMOTT DR STE 120
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-5424
Practice Address - Country:US
Practice Address - Phone:972-396-2021
Practice Address - Fax:972-396-0242
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX5198TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXU60162Medicare UPIN
TX8D2536Medicare ID - Type Unspecified