Provider Demographics
NPI:1285042994
Name:BRUDER, LEAH DAY (OD)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:DAY
Last Name:BRUDER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LEAH
Other - Middle Name:DAY
Other - Last Name:BECKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:11445 15 MILE RD
Mailing Address - Street 2:
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-3809
Mailing Address - Country:US
Mailing Address - Phone:586-268-5804
Mailing Address - Fax:586-268-5813
Practice Address - Street 1:11445 15 MILE RD
Practice Address - Street 2:
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-3809
Practice Address - Country:US
Practice Address - Phone:586-268-5804
Practice Address - Fax:586-268-5813
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901004860152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist