Provider Demographics
NPI:1194816009
Name:LEADER, SUSAN B (OD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:B
Last Name:LEADER
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 1:61 STILLMAN RD
Mailing Address - Street 2:
Mailing Address - City:LYNNFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01940-1704
Mailing Address - Country:US
Mailing Address - Phone:781-334-6972
Mailing Address - Fax:
Practice Address - Street 1:474 LOWELL ST
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-1385
Practice Address - Country:US
Practice Address - Phone:978-535-3644
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3521152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist