Provider Demographics
NPI:1497867600
Name:FORBES, LEONARD H (OD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:H
Last Name:FORBES
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 1:12737 GLENOAKS BLVD
Mailing Address - Street 2:SUITE 3
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-4724
Mailing Address - Country:US
Mailing Address - Phone:818-367-1015
Mailing Address - Fax:818-367-3593
Practice Address - Street 1:12737 GLENOAKS BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-4724
Practice Address - Country:US
Practice Address - Phone:818-367-1015
Practice Address - Fax:818-367-3593
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2011-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT4873TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1497867600Medicaid
CAOP4873Medicare PIN
CAOP4873Medicare UPIN