Provider Demographics
NPI:1275665929
Name:DUFF, LEROY DAVID (OD)
Entity Type:Individual
Prefix:DR
First Name:LEROY
Middle Name:DAVID
Last Name:DUFF
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1057 THOMAS AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55405-2114
Mailing Address - Country:US
Mailing Address - Phone:612-377-4143
Mailing Address - Fax:
Practice Address - Street 1:1127 SHAKOPEE TOWN SQ
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-1908
Practice Address - Country:US
Practice Address - Phone:952-445-1132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1923152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist