Provider Demographics
NPI:1376620385
Name:LEARY AND JESSER, INC.
Entity Type:Organization
Organization Name:LEARY AND JESSER, INC.
Other - Org Name:CALIFORNIA VEIN SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:HAROLD
Authorized Official - Last Name:JESSER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-515-9377
Mailing Address - Street 1:400 WESTMINSTER AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-4217
Mailing Address - Country:US
Mailing Address - Phone:949-515-9377
Mailing Address - Fax:949-515-9378
Practice Address - Street 1:400 WESTMINSTER AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-4217
Practice Address - Country:US
Practice Address - Phone:949-515-9377
Practice Address - Fax:949-515-9378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W16814Medicare ID - Type Unspecified