Provider Demographics
NPI:1497756340
Name:LEACH, MINDY STERNER (OD)
Entity Type:Individual
Prefix:
First Name:MINDY
Middle Name:STERNER
Last Name:LEACH
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 1:2012 14TH ST SW
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59404-3486
Mailing Address - Country:US
Mailing Address - Phone:406-452-4527
Mailing Address - Fax:406-453-1900
Practice Address - Street 1:2012 14TH ST SW
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59404-3486
Practice Address - Country:US
Practice Address - Phone:406-452-4527
Practice Address - Fax:406-453-1900
Is Sole Proprietor?:No
Enumeration Date:2005-08-02
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT540152W00000X, 152WX0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WX0102XEye and Vision Services ProvidersOptometristOccupational Vision
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0482833Medicaid
MTM000002905Medicare PIN
MT0482833Medicaid