Provider Demographics
NPI:1326024704
Name:BARRY LEONARD OD INC
Entity Type:Organization
Organization Name:BARRY LEONARD OD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:818-891-6711
Mailing Address - Street 1:14425 CHASE ST
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-3016
Mailing Address - Country:US
Mailing Address - Phone:818-891-6711
Mailing Address - Fax:818-891-5272
Practice Address - Street 1:14425 CHASE ST
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-3016
Practice Address - Country:US
Practice Address - Phone:818-891-6711
Practice Address - Fax:818-891-5272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-19
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7826T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0078260Medicaid
CAOP7826Medicare ID - Type Unspecified