Provider Demographics
NPI:1689939456
Name:MAST, LEIGH ANN (OD)
Entity Type:Individual
Prefix:
First Name:LEIGH
Middle Name:ANN
Last Name:MAST
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LEIGH
Other - Middle Name:ANN
Other - Last Name:MILLBOURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2317 SW 320TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98023-2567
Mailing Address - Country:US
Mailing Address - Phone:253-952-5547
Mailing Address - Fax:
Practice Address - Street 1:2317 SW 320TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98023-2567
Practice Address - Country:US
Practice Address - Phone:253-952-5547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-09
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60301603152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist