Provider Demographics
NPI:1417911157
Name:CONTARDO, LEONARD (OD)
Entity Type:Individual
Prefix:
First Name:LEONARD
Middle Name:
Last Name:CONTARDO
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 1:930 COMMONWEALTH AVE
Mailing Address - Street 2:SUITE 2A
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-1274
Mailing Address - Country:US
Mailing Address - Phone:617-262-2020
Mailing Address - Fax:617-236-6323
Practice Address - Street 1:300 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:ALLSTON
Practice Address - State:MA
Practice Address - Zip Code:02134-1030
Practice Address - Country:US
Practice Address - Phone:617-783-0500
Practice Address - Fax:617-783-5540
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2873152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA221892OtherMEDICARE CCN
MA1114175916OtherGROUP NPI#
MA1114175916Medicare PIN
MA221892Medicare PIN
MA1114175916OtherGROUP NPI#
MAW17576Medicare ID - Type Unspecified
MA1114175916Medicare NSC
MAM12043Medicare PIN