Provider Demographics
NPI:1578656344
Name:LELAND, BARNET LOUIS (OD)
Entity Type:Individual
Prefix:DR
First Name:BARNET
Middle Name:LOUIS
Last Name:LELAND
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 1:3629 VALLEYVIEW LN
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48323-3363
Mailing Address - Country:US
Mailing Address - Phone:248-626-4189
Mailing Address - Fax:
Practice Address - Street 1:39087 GARFIELD RD
Practice Address - Street 2:
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-2789
Practice Address - Country:US
Practice Address - Phone:586-286-7200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4901002976152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI944463360Medicaid
MIBL002976OtherBCBS OF MI
MIBL002976OtherBCBS OF MI
MIU34859Medicare UPIN