Provider Demographics
NPI:1841240389
Name:LEAHY, MICHAEL (OD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:LEAHY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10001 W 143RD ST
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60462-2026
Mailing Address - Country:US
Mailing Address - Phone:708-349-2600
Mailing Address - Fax:708-349-2600
Practice Address - Street 1:10001 W 143RD ST
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60462-2026
Practice Address - Country:US
Practice Address - Phone:708-349-2600
Practice Address - Fax:708-349-2600
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046007442152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0410017674OtherRR MEDICARE IND ORLAND PK
ILCN3870OtherRR MEDICARE GROUP NUMBER
IL0363448367OtherTAX ID ORLAND PARK
IL1148260001OtherDME/OP
IL508980OtherMEDICARE GROUP OL
ILDA8522OtherRR MEDICARE GROUP OP
ILT365669OtherUPIN/ OL GROUP
IL0410022638OtherRR MEDICARE IND. OAK LAWN
IL0363241858OtherTAX ID OAK LAWN
IL0618250001OtherDME
IL985800OtherMEDICARE GROUP/ OP
ILW22602OtherUPIN/GROUP OP
IL0618250001OtherDME
ILT36671Medicare UPIN
IL985800OtherMEDICARE GROUP/ OP