Provider Demographics
NPI:1225442759
Name:LEPPEK, JOSEPH MATTHEW (OD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:MATTHEW
Last Name:LEPPEK
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 1:1425 N LEROY ST
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MI
Mailing Address - Zip Code:48430-2763
Mailing Address - Country:US
Mailing Address - Phone:810-629-2041
Mailing Address - Fax:810-629-9366
Practice Address - Street 1:1425 N. LEROY ST.
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MI
Practice Address - Zip Code:48430
Practice Address - Country:US
Practice Address - Phone:810-629-2041
Practice Address - Fax:810-629-9366
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-12
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004827152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist