Provider Demographics
NPI:1467932558
Name:BOHNERT, LEAH MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:LEAH
Middle Name:MARIE
Last Name:BOHNERT
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 1:9429 N BEACH ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76244-9059
Mailing Address - Country:US
Mailing Address - Phone:817-442-2020
Mailing Address - Fax:682-499-3856
Practice Address - Street 1:9429 N BEACH ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-9059
Practice Address - Country:US
Practice Address - Phone:817-442-2020
Practice Address - Fax:682-499-3856
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9533T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist