Provider Demographics
NPI:1689883316
Name:THOMAS LEECH, O.D.,P.C.
Entity Type:Organization
Organization Name:THOMAS LEECH, O.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:LEECH
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:541-672-7428
Mailing Address - Street 1:2282 NW TROOST ST STE 104
Mailing Address - Street 2:
Mailing Address - City:ROSEBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97470-6072
Mailing Address - Country:US
Mailing Address - Phone:541-672-7428
Mailing Address - Fax:541-672-7430
Practice Address - Street 1:2282 NW TROOST ST STE 104
Practice Address - Street 2:
Practice Address - City:ROSEBURG
Practice Address - State:OR
Practice Address - Zip Code:97470-6072
Practice Address - Country:US
Practice Address - Phone:541-672-7428
Practice Address - Fax:541-672-7430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR1490T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR116396Medicare ID - Type Unspecified