Provider Demographics
NPI:1588830632
Name:LEANN GOSLAK OD AND ASSOCIATES LLC
Entity Type:Organization
Organization Name:LEANN GOSLAK OD AND ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:LEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOSLAK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-726-6302
Mailing Address - Street 1:265 BOARDMAN CANFIELD RD
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4806
Mailing Address - Country:US
Mailing Address - Phone:330-726-6302
Mailing Address - Fax:330-726-0025
Practice Address - Street 1:265 BOARDMAN CANFIELD RD
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-4806
Practice Address - Country:US
Practice Address - Phone:330-726-6302
Practice Address - Fax:330-726-0025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-07
Last Update Date:2010-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHOH4893/T1762152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U79066Medicare UPIN
OH0899211Medicare PIN