Provider Demographics
NPI:1598148892
Name:LEIS, OSCAR (OD)
Entity Type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:
Last Name:LEIS
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 1:22 W 13TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-7902
Mailing Address - Country:US
Mailing Address - Phone:212-807-0019
Mailing Address - Fax:212-727-2395
Practice Address - Street 1:22 W 13TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-7902
Practice Address - Country:US
Practice Address - Phone:212-807-0019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-04
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008292152W00000X
NYTUV008292-1390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program