Provider Demographics
NPI:1689648941
Name:LEAVITT, GEORGE DAMON III (OD)
Entity Type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:DAMON
Last Name:LEAVITT
Suffix:III
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 1:8 LAUREL ST
Mailing Address - Street 2:
Mailing Address - City:WHITMAN
Mailing Address - State:MA
Mailing Address - Zip Code:02382-2436
Mailing Address - Country:US
Mailing Address - Phone:781-447-2691
Mailing Address - Fax:781-447-3637
Practice Address - Street 1:8 LAUREL ST
Practice Address - Street 2:
Practice Address - City:WHITMAN
Practice Address - State:MA
Practice Address - Zip Code:02382-2436
Practice Address - Country:US
Practice Address - Phone:781-447-2691
Practice Address - Fax:781-447-3637
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2010-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2195152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000026759OtherBOSTON MEDICAL CENTER
0025911OtherNEIGHBORHOOD HEALTH
0600780001OtherTRAVELERS
440000426OtherRAILROAD MEDICARE
725525OtherTUFTS
118320OtherEYE MEDICAL
13344001OtherOXFORD HEALTH PLANS
MALEW15317OtherBLUE CROSS BLUE SHIELD
000000026759OtherHEALTHNET BMC
725525OtherSECURE HORIZONS
MA0332593Medicaid
4062840001OtherDME
725525OtherSECURE HORIZONS
4062840001OtherDME