Provider Demographics
NPI:1689728925
Name:LEONARD OPTICIAN, INC.
Entity Type:Organization
Organization Name:LEONARD OPTICIAN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:J
Authorized Official - Last Name:DUPELL
Authorized Official - Suffix:SR
Authorized Official - Credentials:OPTICIAN
Authorized Official - Phone:978-249-9033
Mailing Address - Street 1:119 NEW ATHOL RD
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:MA
Mailing Address - Zip Code:01364-9603
Mailing Address - Country:US
Mailing Address - Phone:978-249-9033
Mailing Address - Fax:978-249-9020
Practice Address - Street 1:119 NEW ATHOL RD
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:MA
Practice Address - Zip Code:01364-9603
Practice Address - Country:US
Practice Address - Phone:978-249-9033
Practice Address - Fax:978-249-9020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4072332H00000X
MA79332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332H00000XSuppliersEyewear Supplier
Not Answered332S00000XSuppliersHearing Aid Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1529102Medicaid
8568OtherDAVIS VISION
MA40187OtherFALLON COMMUNITY HEALTH
608181OtherTUFTS HEALTH PLAN
MA4072OtherEYEMED VISION
MA40187OtherFALLON COMMUNITY HEALTH