Provider Demographics
NPI:1558512715
Name:LEYDE, KAREN LEE
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:LEE
Last Name:LEYDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6575 CAHILL AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:INVER GROVE HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55076-2061
Mailing Address - Country:US
Mailing Address - Phone:651-451-1100
Mailing Address - Fax:651-451-3939
Practice Address - Street 1:6575 CAHILL AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55076-2061
Practice Address - Country:US
Practice Address - Phone:651-451-1100
Practice Address - Fax:651-451-3939
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-07
Last Update Date:2010-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6C243EYOtherBLUE CROSS BLUE SHIELD
MN493719800Medicaid
MNC05047OtherMEDICARE