Provider Demographics
NPI:1427041680
Name:MOSER, LEIGH A (OD)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:A
Last Name:MOSER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:542 N OAK ST
Mailing Address - Street 2:
Mailing Address - City:LITITZ
Mailing Address - State:PA
Mailing Address - Zip Code:17543-6804
Mailing Address - Country:US
Mailing Address - Phone:717-626-8300
Mailing Address - Fax:717-626-0166
Practice Address - Street 1:65 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LITITZ
Practice Address - State:PA
Practice Address - Zip Code:17543-1941
Practice Address - Country:US
Practice Address - Phone:717-626-8100
Practice Address - Fax:717-626-0389
Is Sole Proprietor?:No
Enumeration Date:2005-08-23
Last Update Date:2016-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG0000307152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0300830001Medicare NSC
PA648849FGXMedicare ID - Type Unspecified
PAT65109Medicare UPIN
PA109027Medicare ID - Type UnspecifiedGROUP #