Provider Demographics
NPI:1760561104
Name:LAPE-STOUDT, LEANNA K (OD)
Entity Type:Individual
Prefix:
First Name:LEANNA
Middle Name:K
Last Name:LAPE-STOUDT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:LEANNA
Other - Middle Name:K
Other - Last Name:LAPE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:890 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EPHRATA
Mailing Address - State:PA
Mailing Address - Zip Code:17522-2562
Mailing Address - Country:US
Mailing Address - Phone:717-721-6686
Mailing Address - Fax:
Practice Address - Street 1:890 E MAIN ST
Practice Address - Street 2:
Practice Address - City:EPHRATA
Practice Address - State:PA
Practice Address - Zip Code:17522-2562
Practice Address - Country:US
Practice Address - Phone:717-721-6686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-05
Last Update Date:2021-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG001168152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0000001743637Medicaid
PA006782Medicare PIN
PA0000001743637Medicaid
PA006782NF9Medicare UPIN