Provider Demographics
NPI:1134474174
Name:R W LEITNER OD LLC
Entity Type:Organization
Organization Name:R W LEITNER OD LLC
Other - Org Name:LEITNER EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:LEITNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:229-888-3298
Mailing Address - Street 1:3526 WEXFORD DR
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31721-2020
Mailing Address - Country:US
Mailing Address - Phone:229-888-3298
Mailing Address - Fax:
Practice Address - Street 1:716-C 16TH AVE EAST
Practice Address - Street 2:
Practice Address - City:CORDELE
Practice Address - State:GA
Practice Address - Zip Code:31015
Practice Address - Country:US
Practice Address - Phone:229-273-2376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-16
Last Update Date:2015-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT000985152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty