Provider Demographics
NPI:1497980833
Name:LEAVITT VISION ASSOCIATES
Entity Type:Organization
Organization Name:LEAVITT VISION ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEAVITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-863-0647
Mailing Address - Street 1:350 N MILWAUKEE ST STE 1188
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-9128
Mailing Address - Country:US
Mailing Address - Phone:208-376-0893
Mailing Address - Fax:208-376-3029
Practice Address - Street 1:350 N MILWAUKEE ST STE 1188
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-9128
Practice Address - Country:US
Practice Address - Phone:208-376-0893
Practice Address - Fax:208-376-3029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-28
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP-100165152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty