Provider Demographics
NPI:1821285016
Name:DUDLEY, LEANNA MARIE (OD)
Entity Type:Individual
Prefix:
First Name:LEANNA
Middle Name:MARIE
Last Name:DUDLEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9340 FENTON CT
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-6520
Mailing Address - Country:US
Mailing Address - Phone:503-866-7244
Mailing Address - Fax:
Practice Address - Street 1:2301 FORD ST
Practice Address - Street 2:
Practice Address - City:GOLDEN
Practice Address - State:CO
Practice Address - Zip Code:80401-2427
Practice Address - Country:US
Practice Address - Phone:303-278-2020
Practice Address - Fax:303-279-7623
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY56007344152WV0400X
CO2707152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152W00000XEye and Vision Services ProvidersOptometrist