Provider Demographics
NPI:1316550882
Name:LEAHY, BREDA MARIA (OD)
Entity Type:Individual
Prefix:DR
First Name:BREDA
Middle Name:MARIA
Last Name:LEAHY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:BREDA LEAHY
Mailing Address - Street 2:44 LAKESIDE DR
Mailing Address - City:NORTH SALEM
Mailing Address - State:NY
Mailing Address - Zip Code:10560
Mailing Address - Country:US
Mailing Address - Phone:908-432-0296
Mailing Address - Fax:
Practice Address - Street 1:BREDA LEAHY
Practice Address - Street 2:44 LAKESIDE DR
Practice Address - City:NORTH SALEM
Practice Address - State:NY
Practice Address - Zip Code:10560
Practice Address - Country:US
Practice Address - Phone:908-432-0296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006157152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision