Provider Demographics
NPI:1609904945
Name:LEIN, BOB DALE (OD)
Entity Type:Individual
Prefix:DR
First Name:BOB
Middle Name:DALE
Last Name:LEIN
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:136 LINDEN DR STE 104
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:VA
Mailing Address - Zip Code:22601-6900
Mailing Address - Country:US
Mailing Address - Phone:540-678-3588
Mailing Address - Fax:540-678-9025
Practice Address - Street 1:1845 PLAZA DR
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:VA
Practice Address - Zip Code:22601-6365
Practice Address - Country:US
Practice Address - Phone:540-662-4512
Practice Address - Fax:540-722-5284
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0618001463152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAP00916029OtherRR MEDICARE
VAP00916029OtherRR MEDICARE