Provider Demographics
NPI:1790066553
Name:DR BYRON W LEEDS OD PA
Entity Type:Organization
Organization Name:DR BYRON W LEEDS OD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BYRON
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:LEEDS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:407-249-8666
Mailing Address - Street 1:2854 PALMETTO RIDGE PT
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-7370
Mailing Address - Country:US
Mailing Address - Phone:407-977-2821
Mailing Address - Fax:
Practice Address - Street 1:11250 E COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-4537
Practice Address - Country:US
Practice Address - Phone:407-249-8666
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3303152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty