Provider Demographics
NPI:1578667986
Name:ACHIRON, LEONARD (OD)
Entity Type:Individual
Prefix:DR
First Name:LEONARD
Middle Name:
Last Name:ACHIRON
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 1:3619 S FULTON AVE
Mailing Address - Street 2:
Mailing Address - City:HAPEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30354-1710
Mailing Address - Country:US
Mailing Address - Phone:404-765-2020
Mailing Address - Fax:404-765-3884
Practice Address - Street 1:3619 S FULTON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:HAPEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30354-1710
Practice Address - Country:US
Practice Address - Phone:404-765-2020
Practice Address - Fax:404-765-3884
Is Sole Proprietor?:No
Enumeration Date:2006-09-08
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA1307152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00536016CMedicaid
GA00536016CMedicaid
GAU06397Medicare UPIN