Provider Demographics
NPI:1114089836
Name:PRESS, LEONARD J (OD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:J
Last Name:PRESS
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17-10 FAIR LAWN AVE
Mailing Address - Street 2:2ND FL
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-2324
Mailing Address - Country:US
Mailing Address - Phone:201-794-7977
Mailing Address - Fax:201-794-7347
Practice Address - Street 1:17-10 FAIR LAWN AVE
Practice Address - Street 2:2ND FL
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-2324
Practice Address - Country:US
Practice Address - Phone:201-794-7977
Practice Address - Fax:201-794-7347
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-16
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27TO00029900152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJT81537Medicare UPIN
NJ521589Medicare PIN